Healthcare Provider Details

I. General information

NPI: 1265272256
Provider Name (Legal Business Name): AMAZING U COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 BAKER ST
HILLSIDE NJ
07205-2612
US

IV. Provider business mailing address

1224 BAKER ST
HILLSIDE NJ
07205-2612
US

V. Phone/Fax

Practice location:
  • Phone: 646-571-7898
  • Fax:
Mailing address:
  • Phone: 646-571-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: REBECCA MICIAL
Title or Position: CEO
Credential:
Phone: 646-571-7898