Provider Demographics
NPI:1730456575
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:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-260-7834
Mailing Address - Street 1:4825 W BEECHER ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4825 W BEECHER ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4603
Practice Address - Country:US
Practice Address - Phone:614-260-7834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28198833A311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home