Provider Demographics
NPI:1760144893
Name:AMAZING GRACE IN-HOME CARE AGENCY
Entity Type:Organization
Organization Name:AMAZING GRACE IN-HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-704-5644
Mailing Address - Street 1:532 CITY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1244
Mailing Address - Country:US
Mailing Address - Phone:973-704-5644
Mailing Address - Fax:
Practice Address - Street 1:532 CITY VIEW DR
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-1244
Practice Address - Country:US
Practice Address - Phone:973-704-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care