Provider Demographics
NPI:1528251808
Name:AMAZING GRACES, INC
Entity type:Organization
Organization Name:AMAZING GRACES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-583-5039
Mailing Address - Street 1:236 LESLIE ROAD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9520
Mailing Address - Country:US
Mailing Address - Phone:919-583-5039
Mailing Address - Fax:
Practice Address - Street 1:111 E 3RD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0399
Practice Address - Country:US
Practice Address - Phone:252-375-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health