Provider Demographics
NPI:1245988898
Name:AMAZING GRACE ADULT DAY CARE AND IN-HOME SERVICES
Entity type:Organization
Organization Name:AMAZING GRACE ADULT DAY CARE AND IN-HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:662-295-6406
Mailing Address - Street 1:7141 HIGHWAY 45 ALT N
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9444
Mailing Address - Country:US
Mailing Address - Phone:662-524-4319
Mailing Address - Fax:662-524-4396
Practice Address - Street 1:7141 HIGHWAY 45 ALT N
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9444
Practice Address - Country:US
Practice Address - Phone:662-524-4319
Practice Address - Fax:662-524-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care