Provider Demographics
NPI:1205577707
Name:SOLACE, LLC.
Entity type:Organization
Organization Name:SOLACE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-727-7740
Mailing Address - Street 1:12301 AMHERST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-8123
Mailing Address - Country:US
Mailing Address - Phone:240-727-7740
Mailing Address - Fax:
Practice Address - Street 1:2232 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2431
Practice Address - Country:US
Practice Address - Phone:240-727-7740
Practice Address - Fax:240-512-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)