Provider Demographics
NPI:1629409636
Name:AMAZING HOMECARE AND NURSING SERVICES,LLC
Entity Type:Organization
Organization Name:AMAZING HOMECARE AND NURSING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:NDIFOR-AJAGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-413-4952
Mailing Address - Street 1:6440 FLYING CLOUD DR STE 114
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3321
Mailing Address - Country:US
Mailing Address - Phone:952-884-1800
Mailing Address - Fax:
Practice Address - Street 1:6440 FLYING CLOUD DR STE 114
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3321
Practice Address - Country:US
Practice Address - Phone:952-884-1800
Practice Address - Fax:844-829-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health