Provider Demographics
NPI:1134352909
Name:ABUNDANT GRACE HEALTH CARE INC.
Entity type:Organization
Organization Name:ABUNDANT GRACE HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUBIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-496-5027
Mailing Address - Street 1:8629 LIBERTY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4713
Mailing Address - Country:US
Mailing Address - Phone:410-496-5027
Mailing Address - Fax:
Practice Address - Street 1:8629 LIBERTY RD
Practice Address - Street 2:SUITE D
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4713
Practice Address - Country:US
Practice Address - Phone:410-496-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1186251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41300200Medicaid