Provider Demographics
NPI:1447364591
Name:GRACE MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:GRACE MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CHIBUIKE
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-444-1443
Mailing Address - Street 1:5718 HARFORD RD
Mailing Address - Street 2:SUITE G1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2237
Mailing Address - Country:US
Mailing Address - Phone:410-444-1443
Mailing Address - Fax:410-444-4394
Practice Address - Street 1:5718 HARFORD RD
Practice Address - Street 2:SUITE G1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2237
Practice Address - Country:US
Practice Address - Phone:410-444-1443
Practice Address - Fax:410-444-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4855410001Medicare NSC