MEDICARE: AMAZING SUPPORTS SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1225899727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING SUPPORTS SERVICES LLC

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY STE 324B
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	703-509-8778
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY STE 324B
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	703-509-8778
Fax Number	:

Authorized Official
Title or Position	:	PD
Name	:	NELLY TUTUWAN
Credential	:	MA
Telephone Number	:	703-509-8778

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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