Provider Demographics
NPI:1568218337
Name:AMAZING GRACE HOME CARE LLC
Entity Type:Organization
Organization Name:AMAZING GRACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAUNTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-384-9899
Mailing Address - Street 1:4156 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-5023
Mailing Address - Country:US
Mailing Address - Phone:317-384-9899
Mailing Address - Fax:
Practice Address - Street 1:4156 N ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-5023
Practice Address - Country:US
Practice Address - Phone:317-384-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care