Provider Demographics
NPI:1326432071
Name:AMAZING GRACE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:AMAZING GRACE HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-788-0404
Mailing Address - Street 1:7130 MAGNOLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3864
Mailing Address - Country:US
Mailing Address - Phone:951-788-0404
Mailing Address - Fax:951-788-0303
Practice Address - Street 1:7130 MAGNOLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3864
Practice Address - Country:US
Practice Address - Phone:951-788-0404
Practice Address - Fax:951-788-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based