Provider Demographics
NPI:1669864674
Name:I'M STILL STANDING BY GRACE
Entity Type:Organization
Organization Name:I'M STILL STANDING BY GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CPC, CAC-AD
Authorized Official - Phone:443-831-0191
Mailing Address - Street 1:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-0727
Mailing Address - Country:US
Mailing Address - Phone:443-831-0191
Mailing Address - Fax:
Practice Address - Street 1:1003 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2228
Practice Address - Country:US
Practice Address - Phone:443-312-6237
Practice Address - Fax:443-312-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid