Provider Demographics
NPI:1023353588
Name:AMAZING GRACE HOME CARE LLC
Entity type:Organization
Organization Name:AMAZING GRACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:ADAEZE
Authorized Official - Last Name:OGBU
Authorized Official - Suffix:
Authorized Official - Credentials:BSC/MPH
Authorized Official - Phone:651-329-1853
Mailing Address - Street 1:515 E GRANT ST
Mailing Address - Street 2:APT. 311
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1400
Mailing Address - Country:US
Mailing Address - Phone:651-329-1853
Mailing Address - Fax:612-343-8618
Practice Address - Street 1:515 E GRANT ST
Practice Address - Street 2:APT. 311
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1400
Practice Address - Country:US
Practice Address - Phone:651-329-1853
Practice Address - Fax:612-343-8618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3744483140N1450X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric