Provider Demographics
NPI:1740037134
Name:THE GRACE MEDICAL ADULT DAYCARE, LLC
Entity type:Organization
Organization Name:THE GRACE MEDICAL ADULT DAYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNGKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-785-6055
Mailing Address - Street 1:9160 RED BRANCH RD STE E1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2002
Mailing Address - Country:US
Mailing Address - Phone:443-745-2110
Mailing Address - Fax:443-745-4716
Practice Address - Street 1:9160 RED BRANCH RD STE E1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2002
Practice Address - Country:US
Practice Address - Phone:443-745-2110
Practice Address - Fax:443-745-4716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care