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General NPI Number Information
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NPI Number | 1962889147
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE PCA, LLC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 7240 CROWDER BLVD SUITE 203
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City | NEW ORLEANS
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State | LA
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Zip | 70127-1922
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Country | US
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Telephone | 504-309-8190
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Fax | 504-309-8196
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Provider Business Mailing Address
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Address Line | 413 QUEEN ANNE DR
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City | SLIDELL
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State | LA
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Zip | 70460-8439
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Country | US
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Telephone | 504-261-7602
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Fax | 504-248-5302
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DELPHENIA MONTGOMERY LODIONG
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Credential | MBA
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Telephone | 504-261-7602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2203782320
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC0007481
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 2203782320
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License Number State | LA
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