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General NPI Number Information
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NPI Number | 1114688058
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE HOME CARE LLC
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 829 FRONT ST UNIT H
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City | GEORGETOWN
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State | SC
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Zip | 29440-3564
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Country | US
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Telephone | 843-698-0684
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Fax | 843-698-0825
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Provider Business Mailing Address
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Address Line | 586 INDIGO BAY CIR
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-3684
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Country | US
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Telephone | 732-522-3724
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANSI SHAH
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Credential |
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Telephone | 732-522-3724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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