Provider Demographics
NPI:1871913145
Name:AMAZING GRACE HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:AMAZING GRACE HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:MARABLE
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-458-0314
Mailing Address - Street 1:2449 VINEVILLE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2955
Mailing Address - Country:US
Mailing Address - Phone:478-746-1133
Mailing Address - Fax:478-746-9933
Practice Address - Street 1:2449 VINEVILLE AVE STE 7
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2955
Practice Address - Country:US
Practice Address - Phone:478-746-1133
Practice Address - Fax:478-746-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-R-1239251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health