Provider Demographics
NPI:1639857279
Name:BY HIS GRACE HOME SUPPORT AGENCY
Entity Type:Organization
Organization Name:BY HIS GRACE HOME SUPPORT AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KUNGANG
Authorized Official - Middle Name:
Authorized Official - Last Name:MAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-467-0959
Mailing Address - Street 1:9122 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1359
Mailing Address - Country:US
Mailing Address - Phone:240-467-0959
Mailing Address - Fax:
Practice Address - Street 1:600 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5358
Practice Address - Country:US
Practice Address - Phone:240-467-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care