Provider Demographics
NPI:1548595929
Name:AMAZING GRACE
Entity Type:Organization
Organization Name:AMAZING GRACE
Other - Org Name:AMAZING GRACE ASSISTED LIVING HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-887-0888
Mailing Address - Street 1:3521 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4370
Mailing Address - Country:US
Mailing Address - Phone:205-633-3635
Mailing Address - Fax:205-633-3635
Practice Address - Street 1:3016 PINECREST RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-1324
Practice Address - Country:US
Practice Address - Phone:205-887-0888
Practice Address - Fax:205-633-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health