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General NPI Number Information
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NPI Number | 1326846650
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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 | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 7128 W HOODOO PL
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City | SPIRIT LAKE
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State | ID
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Zip | 83869
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Country | US
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Telephone | 208-290-7094
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 152
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City | SPIRIT LAKE
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State | ID
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Zip | 83869-0152
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON KIEHN
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Credential |
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Telephone | 208-290-7094
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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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