Provider Demographics
NPI:1093105058
Name:AMAZING HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:AMAZING HOME CARE AGENCY LLC
Other - Org Name:AMAZING HOME CARE AGENCY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-884-3080
Mailing Address - Street 1:1909 BRAGG BLVD
Mailing Address - Street 2:ST 102 B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4387
Mailing Address - Country:US
Mailing Address - Phone:910-884-3080
Mailing Address - Fax:910-884-0193
Practice Address - Street 1:1909 BRAGG BLVD
Practice Address - Street 2:STE 102 B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4387
Practice Address - Country:US
Practice Address - Phone:910-884-3080
Practice Address - Fax:910-884-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601870Medicaid