Provider Demographics
NPI:1124650023
Name:AMAZING GRACE HOME CARE LLC
Entity type:Organization
Organization Name:AMAZING GRACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:NDUTA
Authorized Official - Last Name:MBUGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-984-7324
Mailing Address - Street 1:54 POWDER VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4796
Mailing Address - Country:US
Mailing Address - Phone:410-984-7324
Mailing Address - Fax:
Practice Address - Street 1:54 POWDER VIEW CT
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4796
Practice Address - Country:US
Practice Address - Phone:410-984-7324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health