Healthcare Provider Details

I. General information

NPI: 1215537436
Provider Name (Legal Business Name): AMAZING LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W CROWELL ST
MONROE NC
28112-4535
US

IV. Provider business mailing address

1201 W CROWELL ST
MONROE NC
28112-4535
US

V. Phone/Fax

Practice location:
  • Phone: 478-919-8881
  • Fax: 803-802-3915
Mailing address:
  • Phone: 478-919-8881
  • Fax: 803-802-3915

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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: HEWIS BARTELS
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 478-919-8881