Healthcare Provider Details

I. General information

NPI: 1629888441
Provider Name (Legal Business Name): AMAZING GRACE BEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 CLARE AVE
PORTSMOUTH OH
45662-2583
US

IV. Provider business mailing address

802 CLARE AVE
PORTSMOUTH OH
45662-2583
US

V. Phone/Fax

Practice location:
  • Phone: 740-876-8449
  • Fax:
Mailing address:
  • Phone: 740-876-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSE ONYINYECHI URADU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 740-876-8449