Organization
GRACE RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OMOLARA O ADEOLA (CEO)
(443) 677-7130
Entity
Organization
Contact information
Practice address
4117 BROOKSIDE OAKS ROAD, OWINGS MILLS, MD 21117
(443) 677-7130
Mailing address
4117 BROOKSIDE OAKS ROAD, OWINGS MILLS, MD 21117
(443) 677-7130
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122456
—
MD
Enumeration date
02/18/2019
Last updated
02/18/2019
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