Provider Demographics
NPI:1003575309
Name:AMAZING GRACE 1 AFH LCC
Entity Type:Organization
Organization Name:AMAZING GRACE 1 AFH LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, BSN
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIAMBUTHIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:469-456-2804
Mailing Address - Street 1:2304 E 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6902
Mailing Address - Country:US
Mailing Address - Phone:469-456-2804
Mailing Address - Fax:509-315-8899
Practice Address - Street 1:2304 E 60TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6902
Practice Address - Country:US
Practice Address - Phone:469-456-2804
Practice Address - Fax:509-315-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty