Provider Demographics
NPI:1700131448
Name:AMAZING GRACE HOSPICE & PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:AMAZING GRACE HOSPICE & PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-333-6704
Mailing Address - Street 1:15723 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-4469
Mailing Address - Country:US
Mailing Address - Phone:708-333-6704
Mailing Address - Fax:708-333-7204
Practice Address - Street 1:15723 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-4469
Practice Address - Country:US
Practice Address - Phone:708-333-6704
Practice Address - Fax:708-333-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based