Healthcare Provider Details

I. General information

NPI: 1811883861
Provider Name (Legal Business Name): AMAZING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WESTCHESTER PARK DR APT 905
COLLEGE PARK MD
20740-2839
US

IV. Provider business mailing address

6200 WESTCHESTER PARK DR APT 905
COLLEGE PARK MD
20740-2839
US

V. Phone/Fax

Practice location:
  • Phone: 240-784-1589
  • Fax:
Mailing address:
  • Phone: 240-784-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OPEYEMI KOMOLAFE
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-784-1589