Provider Demographics
NPI:1619146461
Name:GRACE NURSING CENTER INC
Entity Type:Organization
Organization Name:GRACE NURSING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAIYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIMOLADE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-792-1355
Mailing Address - Street 1:14626 MONMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1925
Mailing Address - Country:US
Mailing Address - Phone:301-792-1355
Mailing Address - Fax:
Practice Address - Street 1:14626 MONMOUTH DR
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1925
Practice Address - Country:US
Practice Address - Phone:301-792-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home