Provider Demographics
NPI:1922987361
Name:GRACE PRIMARY & URGENT CARE, LLC
Entity type:Organization
Organization Name:GRACE PRIMARY & URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:KYI
Authorized Official - Middle Name:WIN
Authorized Official - Last Name:KYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-300-0359
Mailing Address - Street 1:5445 LAVERNE AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5369
Mailing Address - Country:US
Mailing Address - Phone:410-300-0359
Mailing Address - Fax:
Practice Address - Street 1:5445 LAVERNE AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5369
Practice Address - Country:US
Practice Address - Phone:410-300-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care