Provider Demographics
NPI:1205567252
Name:THE MOMENTS OF GRACE
Entity type:Organization
Organization Name:THE MOMENTS OF GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LABBY
Authorized Official - Middle Name:KOLA
Authorized Official - Last Name:AKINSANMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-728-5957
Mailing Address - Street 1:2537 BLADENSBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1420
Mailing Address - Country:US
Mailing Address - Phone:301-728-5957
Mailing Address - Fax:
Practice Address - Street 1:2537 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1420
Practice Address - Country:US
Practice Address - Phone:301-728-5957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty