Provider Demographics
NPI:1528842796
Name:AMAZING GRACE FAMILY &PSYCHIATRY PRACTICE
Entity type:Organization
Organization Name:AMAZING GRACE FAMILY &PSYCHIATRY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-879-7326
Mailing Address - Street 1:9877 GOOD LUCK RD APT 1
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3232
Mailing Address - Country:US
Mailing Address - Phone:240-879-7326
Mailing Address - Fax:
Practice Address - Street 1:15709 BRADFORD DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3260
Practice Address - Country:US
Practice Address - Phone:240-879-7326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty