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General NPI Number Information
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NPI Number | 1548570104
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE HEALTH SERVICES INC.
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 1477 SNAPDRAGON COURT
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City | ROMEOVILLE
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State | IL
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Zip | 60446
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Country | US
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Telephone | 815-888-6496
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Fax | 815-886-4983
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Provider Business Mailing Address
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Address Line | 1477 SNAPDRAGON COURT
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City | ROMEOVILLE
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State | IL
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Zip | 60446
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Country | US
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Telephone | 815-888-6496
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Fax | 815-886-4983
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. CHRISTIAN CHIBEZE NKEMEH
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Credential | PH.D
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Telephone | 630-988-2615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2002251
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License Number State | IL
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