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General NPI Number Information
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NPI Number | 1154011104
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE HOSPICE CARE, LLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 168 N JOHNSTON ST STE 104
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City | DALLAS
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State | GA
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Zip | 30132-4740
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Country | US
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Telephone | 470-474-9181
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Fax |
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Provider Business Mailing Address
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Address Line | 168 N JOHNSTON ST STE 104
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City | DALLAS
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State | GA
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Zip | 30132-4740
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Country | US
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Telephone | 470-474-9181
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAURA MICHAEL HUBBARD
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Credential |
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Telephone | 470-474-9181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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