Provider Demographics
NPI:1215700521
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNTUASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-841-8320
Mailing Address - Street 1:6065 N GIBRALTER CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2292
Mailing Address - Country:US
Mailing Address - Phone:720-458-3062
Mailing Address - Fax:
Practice Address - Street 1:6065 N GIBRALTER CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80019-2292
Practice Address - Country:US
Practice Address - Phone:720-458-3062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health