Healthcare Provider Details

I. General information

NPI: 1477885309
Provider Name (Legal Business Name): AMAZING GRACE HOME CARE OF ELKIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044B N BRIDGE ST
ELKIN NC
28621-2108
US

IV. Provider business mailing address

2044B N BRIDGE ST
ELKIN NC
28621-2108
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-1362
  • Fax: 336-835-1754
Mailing address:
  • Phone: 336-835-1362
  • Fax: 336-835-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3895
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3895
License Number StateNC

VIII. Authorized Official

Name: MS. SARAH WHEELER MARTIN
Title or Position: OWNER/DIRECTOR
Credential: RN
Phone: 336-835-1362