Provider Demographics
NPI:1811202070
Name:AMAZING GRACE PERSONAL CARE
Entity Type:Organization
Organization Name:AMAZING GRACE PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-249-4562
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:LA
Mailing Address - Zip Code:71226-0386
Mailing Address - Country:US
Mailing Address - Phone:318-249-4562
Mailing Address - Fax:
Practice Address - Street 1:103 W BOUNDARY AVE STE 102
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2776
Practice Address - Country:US
Practice Address - Phone:318-249-4562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services