Provider Demographics
NPI:1871863449
Name:AMAZING GRACE MY CHOICE INC
Entity Type:Organization
Organization Name:AMAZING GRACE MY CHOICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-603-3831
Mailing Address - Street 1:8727 COMMERCE PARK PL
Mailing Address - Street 2:SUITE L
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3168
Mailing Address - Country:US
Mailing Address - Phone:317-603-3831
Mailing Address - Fax:
Practice Address - Street 1:8727 COMMERCE PARK PL
Practice Address - Street 2:SUITE L
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3168
Practice Address - Country:US
Practice Address - Phone:317-603-3831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health