Provider Demographics
NPI:1841554813
Name:AMAZING GRACE NURSING CARE LLC
Entity type:Organization
Organization Name:AMAZING GRACE NURSING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEMO
Authorized Official - Middle Name:MARYSTELLA
Authorized Official - Last Name:ATTEY MOUANJO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:240-408-6204
Mailing Address - Street 1:230 LONGFELLOW STREET NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:240-408-6204
Mailing Address - Fax:
Practice Address - Street 1:230 LONGFELLOW STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:240-408-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING GRACE NURSING CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0173251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health