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General NPI Number Information
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NPI Number | 1871913145
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE HOME CARE SERVICES, INC
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 2449 VINEVILLE AVE STE 7
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City | MACON
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State | GA
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Zip | 31204-2955
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Country | US
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Telephone | 478-746-1133
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Fax | 478-746-9933
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Provider Business Mailing Address
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Address Line | 2449 VINEVILLE AVE STE 7
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City | MACON
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State | GA
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Zip | 31204-2955
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Country | US
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Telephone | 478-746-1133
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Fax | 478-746-9933
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | RONDA MARABLE CARSON
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Credential |
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Telephone | 704-458-0314
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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 | 011-R-1239
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License Number State | GA
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