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General NPI Number Information
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NPI Number | 1043080468
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE ELDER CARE LLC
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 6710 PALM AVE
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City | FAIR OAKS
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State | CA
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Zip | 95628-3238
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Country | US
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Telephone | 916-801-4386
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Fax |
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Provider Business Mailing Address
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Address Line | 6710 PALM AVE
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City | FAIR OAKS
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State | CA
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Zip | 95628-3238
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Country | US
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Telephone | 916-801-4386
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | NATHANIEL STERLING
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Credential |
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Telephone | 916-801-4386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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