Healthcare Provider Details

I. General information

NPI: 1972445096
Provider Name (Legal Business Name): AMAZING GRACE SUPPORTIVE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BENSON RD STE 229
GARNER NC
27529-3397
US

IV. Provider business mailing address

500 BENSON RD STE 229
GARNER NC
27529-3397
US

V. Phone/Fax

Practice location:
  • Phone: 984-234-6110
  • Fax:
Mailing address:
  • Phone: 984-234-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TOREY GREENE
Title or Position: CEO
Credential:
Phone: 984-234-6110