Organization
AMAZING GRACE RESIDENTIAL SERVICES AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD O LANLOKUN (ADMINISTRATOR)
(301) 497-4117
Entity
Organization
Contact information
Practice address
8645 VINTAGE EARTH PATH, LAUREL, MD 20723-5880
(301) 497-4117
Mailing address
8645 VINTAGE EARTH PATH, LAUREL, MD 20723-5880
(301) 497-4117
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
R2546
MD
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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