Healthcare Provider Details

I. General information

NPI: 1629694252
Provider Name (Legal Business Name): AMAZING ANGELS SR.HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 BIRDSONG ST
KNOXVILLE TN
37915-2301
US

IV. Provider business mailing address

1734 BIRDSONG ST
KNOXVILLE TN
37915-2301
US

V. Phone/Fax

Practice location:
  • Phone: 865-801-8866
  • Fax: 865-247-6692
Mailing address:
  • Phone: 865-801-8866
  • Fax: 865-247-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. NADINE ELIZABETH NICHOLS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 865-801-8866