Provider Demographics
NPI:1659088169
Name:AMAZING SKIES HEALTHCARE LLC
Entity Type:Organization
Organization Name:AMAZING SKIES HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-998-3237
Mailing Address - Street 1:4310 INDIAN RIVER RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3100
Mailing Address - Country:US
Mailing Address - Phone:757-998-3237
Mailing Address - Fax:
Practice Address - Street 1:4310 INDIAN RIVER RD STE 2A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-3100
Practice Address - Country:US
Practice Address - Phone:757-998-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care