Healthcare Provider Details

I. General information

NPI: 1194486282
Provider Name (Legal Business Name): AMAZING GRACE 1 AFH LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2022
Last Update Date: 04/15/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 E 60TH AVE
SPOKANE WA
99223-6902
US

IV. Provider business mailing address

2304 E 60TH AVE
SPOKANE WA
99223-6902
US

V. Phone/Fax

Practice location:
  • Phone: 469-456-2804
  • Fax: 509-315-8899
Mailing address:
  • Phone: 509-437-9349
  • Fax: 509-315-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: GRACE WAIRIMU KIAMBUTHIA
Title or Position: RN,BSN
Credential: RN,BSN
Phone: 509-437-9349