Provider Demographics
NPI:1588146906
Name:AMAZING GRACE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:AMAZING GRACE HOME HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANA PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-373-5938
Mailing Address - Street 1:422 HOLTZMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1605
Mailing Address - Country:US
Mailing Address - Phone:561-373-5938
Mailing Address - Fax:614-725-2158
Practice Address - Street 1:422 HOLTZMAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1605
Practice Address - Country:US
Practice Address - Phone:561-373-5938
Practice Address - Fax:614-725-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH327978163W00000X
251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No251J00000XAgenciesNursing Care