=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942534946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMAZING CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2009
-----------------------------------------------------
Last Update Date | 09/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5450 LAFAYETTE RD SUITE 3
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-1689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-757-5848
-----------------------------------------------------
Fax | 317-757-5850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5450 LAFAYETTE RD SUITE 3
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-1689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-757-5848
-----------------------------------------------------
Fax | 317-757-5850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHN MBUGUA MWANGI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-250-4724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 09-012194-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------