Provider Demographics
NPI:1770940041
Name:AMAZG GRACE HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:AMAZG GRACE HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:ADEBAYO
Authorized Official - Last Name:ADEGBOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-884-0432
Mailing Address - Street 1:701 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:919-381-4789
Practice Address - Street 1:701 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2634
Practice Address - Country:US
Practice Address - Phone:919-884-0432
Practice Address - Fax:919-381-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4815251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health