1801808522 NPI number — GRACE INTERNATIONAL SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801808522 NPI number — GRACE INTERNATIONAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRACE INTERNATIONAL SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801808522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N FREDERICK AVE
Provider Second Line Business Mailing Address:
SUITE# 107
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20877-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-216-2660
Provider Business Mailing Address Fax Number:
301-216-2440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 RUSSELL AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-6612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-216-2660
Provider Business Practice Location Address Fax Number:
301-216-2440
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
NAHED
Authorized Official Middle Name:
WAHIB SALEH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-216-2660

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  D01997 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012985200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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