Provider Demographics
NPI:1598256521
Name:AMAZING GRACE CAREGIVERS LLC
Entity Type:Organization
Organization Name:AMAZING GRACE CAREGIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:C
Authorized Official - Last Name:IBENEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-774-3887
Mailing Address - Street 1:17 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1222
Mailing Address - Country:US
Mailing Address - Phone:708-774-3887
Mailing Address - Fax:
Practice Address - Street 1:17 HIGH ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1222
Practice Address - Country:US
Practice Address - Phone:708-774-3887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty