Provider Demographics
NPI:1629888441
Name:AMAZING GRACE BEHAVIORAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:AMAZING GRACE BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ONYINYECHI
Authorized Official - Last Name:URADU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-876-8449
Mailing Address - Street 1:802 CLARE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2583
Mailing Address - Country:US
Mailing Address - Phone:740-876-8449
Mailing Address - Fax:
Practice Address - Street 1:802 CLARE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2583
Practice Address - Country:US
Practice Address - Phone:740-876-8449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING GRACE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)