MEDICARE: AMAZING HANDS HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HCO-13332	VA

General Provider Information

NPI Number	:	1831445154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING HANDS HOME CARE, LLC

Provider Business Mailing Address
First Line	:	4410 CLAIBORNE SQ E
Second Line	:	SUITE 334
City	:	HAMPTON
State	:	VA
Zip	:	23666-2071
Country	:	US
Telephone Number	:	757-251-3775
Fax Number	:	757-251-3801

Provider Business Practice Location Address
First Line	:	4410 CLAIBORNE SQ E
Second Line	:	SUITE 334
City	:	HAMPTON
State	:	VA
Zip	:	23666-2071
Country	:	US
Telephone Number	:	757-251-3775
Fax Number	:	757-251-3801

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MS. YVETTE VONCENT MIX
Credential	:
Telephone Number	:	757-251-3775

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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