Provider Demographics
NPI:1700094331
Name:AMAZING GRACE ALH
Entity Type:Organization
Organization Name:AMAZING GRACE ALH
Other - Org Name:AMAZING GRACE ALH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOVENA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:JEAN-MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-278-0276
Mailing Address - Street 1:3444 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3037
Mailing Address - Country:US
Mailing Address - Phone:907-278-0276
Mailing Address - Fax:907-278-0276
Practice Address - Street 1:3444 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3037
Practice Address - Country:US
Practice Address - Phone:907-278-0276
Practice Address - Fax:907-278-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK732593251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based