Healthcare Provider Details

I. General information

NPI: 1255247052
Provider Name (Legal Business Name): AMAZING GRACE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 21ST ST STE 124
NEWPORT MN
55055-1094
US

IV. Provider business mailing address

PO BOX 210
NEWPORT MN
55055-0210
US

V. Phone/Fax

Practice location:
  • Phone: 651-734-3183
  • Fax: 651-459-0138
Mailing address:
  • Phone: 651-734-3183
  • Fax: 651-459-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GRACE OGHENEKARO OYEFESOBI
Title or Position: OWNER/CEO
Credential: RN
Phone: 651-278-5633