Provider Demographics
NPI:1659806503
Name:AMAZING GRACE HOSPICE INC
Entity Type:Organization
Organization Name:AMAZING GRACE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-403-3678
Mailing Address - Street 1:9892 I AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-5473
Mailing Address - Country:US
Mailing Address - Phone:760-403-3678
Mailing Address - Fax:
Practice Address - Street 1:9892 I AVE
Practice Address - Street 2:STE 5
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-5473
Practice Address - Country:US
Practice Address - Phone:760-403-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based