Provider Demographics
NPI:1316704547
Name:AMAZING GRACE CHRISTIAN SENIOR SERVICES
Entity type:Organization
Organization Name:AMAZING GRACE CHRISTIAN SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JNGILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-562-0026
Mailing Address - Street 1:133 ETHAN MOOR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-5893
Mailing Address - Country:US
Mailing Address - Phone:770-912-4796
Mailing Address - Fax:
Practice Address - Street 1:17 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2190
Practice Address - Country:US
Practice Address - Phone:770-912-4796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility