Graceland Psychiatry LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

GRACELAND PSYCHIATRY LLC

Practice address

10451 Mill Run Cir
Owings Mills, MD 21117-5577

Phone

(888) 517-4888

NPI assigned

Apr 7, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adetimbo Adediran, PMHNPNPI 1679922298

Title

Psychiatric Nurse Practitioner

Phone

(240) 722-9763

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adetimbo Adediran, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Owings Mills, MD
  • NPI 1679922298
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623801600000",
    "number": "1265011928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9435 PARAGON CT",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211171408",
            "telephone_number": "240-722-9763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10451 MILL RUN CIR",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175577",
            "telephone_number": "888-517-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACELAND PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "ADEDIRAN",
        "authorized_official_first_name": "ADETIMBO",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "240-722-9763",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Faith Gorenstein, PH.D.
• Tamisha Gould
• Jessica Gousby, BT
• GPS Clinical Solutions, LLC
• Grace Residential Services, LLC
• Sean P Grady, D.C.
• Ronnie Graham, LCSW-C
• Deborah Sue Grammer, M.ED., CCC-SLP
• Brian Michael Granek, O.D.
• Olivia Grant-Sherlock, LMSW

• Psychiatry Physician in Owings Mills, MD
• Providers in Owings Mills, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.