Provider Demographics
NPI:1083304042
Name:AWESOME GRACE HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:AWESOME GRACE HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:OFURUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-370-1675
Mailing Address - Street 1:2 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-2336
Mailing Address - Country:US
Mailing Address - Phone:847-370-1675
Mailing Address - Fax:
Practice Address - Street 1:2 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-2336
Practice Address - Country:US
Practice Address - Phone:847-370-1675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care