Healthcare Provider Details

I. General information

NPI: 1245411073
Provider Name (Legal Business Name): AMAZING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CONNOR BLVD
BEAR DE
19701-1742
US

IV. Provider business mailing address

310 CONNOR BLVD
BEAR DE
19701-1742
US

V. Phone/Fax

Practice location:
  • Phone: 302-832-3448
  • Fax: 302-832-3248
Mailing address:
  • Phone: 302-832-3448
  • Fax: 302-832-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number20071120154
License Number StateDE

VIII. Authorized Official

Name: MRS. EDIMA JOHNSON IDEMETO
Title or Position: DIRECTOR
Credential:
Phone: 302-218-3400