Provider Demographics
NPI:1932879541
Name:AMAZING PERSONAL SERVICE AGENCY LLC
Entity type:Organization
Organization Name:AMAZING PERSONAL SERVICE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:IKHELOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-704-4317
Mailing Address - Street 1:2346 S LYNHURST DR STE A103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8626
Mailing Address - Country:US
Mailing Address - Phone:872-704-4317
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR STE A103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8626
Practice Address - Country:US
Practice Address - Phone:872-704-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty