Provider Demographics
NPI:1720971286
Name:AMAZING GRACE HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:AMAZING GRACE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-831-2767
Mailing Address - Street 1:115 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5205
Mailing Address - Country:US
Mailing Address - Phone:757-831-2767
Mailing Address - Fax:
Practice Address - Street 1:115 CLAY ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5205
Practice Address - Country:US
Practice Address - Phone:757-831-2767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health