Provider Demographics
NPI:1760268015
Name:AMAZING GRACE
Entity Type:Organization
Organization Name:AMAZING GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE GRACE
Authorized Official - Middle Name:TUAZON
Authorized Official - Last Name:GENATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-856-6568
Mailing Address - Street 1:4565 RUFFNER ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2203
Mailing Address - Country:US
Mailing Address - Phone:858-836-2273
Mailing Address - Fax:
Practice Address - Street 1:4565 RUFFNER ST STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2203
Practice Address - Country:US
Practice Address - Phone:858-836-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty