Provider Demographics
NPI:1578277612
Name:AGING GRACE LLC
Entity Type:Organization
Organization Name:AGING GRACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-926-6323
Mailing Address - Street 1:604 GRAIN CT E
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1657
Mailing Address - Country:US
Mailing Address - Phone:410-926-6323
Mailing Address - Fax:
Practice Address - Street 1:604 GRAIN CT E
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1657
Practice Address - Country:US
Practice Address - Phone:410-926-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)