Provider Demographics
NPI:1487229639
Name:GRACE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:GRACE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:UKAEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:443-275-1031
Mailing Address - Street 1:6600 YORK RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2024
Mailing Address - Country:US
Mailing Address - Phone:443-275-1031
Mailing Address - Fax:443-275-2597
Practice Address - Street 1:6600 YORK RD STE 200B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2024
Practice Address - Country:US
Practice Address - Phone:443-275-1031
Practice Address - Fax:443-275-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty