Individual
STACEY R GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3609 E NORTHERN PKWY, BALTIMORE, MD 21206-1645
(443) 415-1409
Mailing address
3609 E NORTHERN PKWY, BALTIMORE, MD 21206-1645
(443) 415-1409
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
30AL3570-A
MD
Other
Enumeration date
12/12/2024
Last updated
12/12/2024
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