Provider Demographics
NPI:1023703014
Name:AMAZING CARE GROUP HOME LLC
Entity type:Organization
Organization Name:AMAZING CARE GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAM-OBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-505-3182
Mailing Address - Street 1:16730 SWEENEY LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4765
Mailing Address - Country:US
Mailing Address - Phone:225-505-3182
Mailing Address - Fax:
Practice Address - Street 1:16730 SWEENEY LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4765
Practice Address - Country:US
Practice Address - Phone:225-505-3182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities