| Organization Name: | PEACE & GLORY MANOR, LLC |
| NPI Number: | 1023344066 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLORIA LYNN BROWN - BRISTOL (FOUNDER COE/ EXCUTIVE OFFER) |
| Mailing Address: | 3829 Kilburn Rd Randallstown |
| State: | MD US |
| Postal Code: | 211334655 |
| Phone Number: | 4109222617 |
| Fax Number: | 4109224620 |
| NPI Enumeration Date: | 10/27/2009 |
| NPI Last Update Date: | 10/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP2201X |
| License Number: | 03AL1070-A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Ambulatory Care |
| Taxonomy Definition: | |