Provider Demographics
NPI:1558551028
Name:GRACE OUTREACH ADC
Entity Type:Organization
Organization Name:GRACE OUTREACH ADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DEBBIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-466-8702
Mailing Address - Street 1:2605 BANISTER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6505
Mailing Address - Country:US
Mailing Address - Phone:410-466-8702
Mailing Address - Fax:410-466-8706
Practice Address - Street 1:2605 BANISTER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6505
Practice Address - Country:US
Practice Address - Phone:410-466-8702
Practice Address - Fax:410-466-8706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE OUTREACH ADC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14350261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care