MEDICARE: AMAZING GRACE OF WNC, 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1700196904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE OF WNC, LLC

Provider Business Mailing Address
First Line	:	838 OAKLAND RD
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-9680
Country	:	US
Telephone Number	:	828-287-5799
Fax Number	:	828-287-5755

Provider Business Practice Location Address
First Line	:	838 OAKLAND RD
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-9680
Country	:	US
Telephone Number	:	828-287-5799
Fax Number	:	828-287-5755

Authorized Official
Title or Position	:	OWNER, NURSE, DIRECTOR
Name	:	MS. BRENDA M HUTCHENS
Credential	:	RN
Telephone Number	:	828-287-5799

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	03/12/2013

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