Provider Demographics
NPI:1225899727
Name:AMAZING SUPPORTS SERVICES LLC
Entity Type:Organization
Organization Name:AMAZING SUPPORTS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTUWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:703-509-8778
Mailing Address - Street 1:6911 RICHMOND HWY STE 324B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1842
Mailing Address - Country:US
Mailing Address - Phone:703-509-8778
Mailing Address - Fax:
Practice Address - Street 1:6911 RICHMOND HWY STE 324B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1842
Practice Address - Country:US
Practice Address - Phone:703-509-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care