=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326432071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMAZING GRACE HOSPICE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2015
-----------------------------------------------------
Last Update Date | 03/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7130 MAGNOLIA AVE SUITE B
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92504-3864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-788-0404
-----------------------------------------------------
Fax | 951-788-0303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7130 MAGNOLIA AVE SUITE B
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92504-3864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-788-0404
-----------------------------------------------------
Fax | 951-788-0303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES/ADMINISTRATOR
-----------------------------------------------------
Name | MR. SUNDAY R AGUDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-788-0404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------