Organization Active NPI

Amazing Grace Recovery, LLC

  • Health & Wellness Coach
  • Laurel, MD
National Provider Identifier
1710865845
Registry record updated Aug 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health & Wellness CoachTaxonomy code 171400000X
Legal business name
AMAZING GRACE RECOVERY, LLC
Practice address
1106 Patuxent Greens Dr
Laurel, MD 20708-3404
Phone
(202) 359-0493
NPI assigned
Aug 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2025

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

Authorized official

Name
Mr. Malik Keene, COACH
Title
Founder
Phone
(202) 359-0493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health & Wellness CoachGroup: 193400000X SINGLE SPECIALTY GROUP 171400000X Primary

Addresses

Primary practice location

1106 Patuxent Greens Dr
Laurel, MD 20708-3404

Mailing address

1106 Patuxent Greens Dr
Laurel, MD 20708-3404
Phone (202) 359-0493

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1756166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756166400000",
    "number": "1710865845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 PATUXENT GREENS DR",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083404",
            "telephone_number": "202-359-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 PATUXENT GREENS DR",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083404",
            "telephone_number": "202-359-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-26",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A",
        "authorized_official_last_name": "KEENE",
        "authorized_official_first_name": "MALIK",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "202-359-0493",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "COACH"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.