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Organization
AMAZING GRACE PCA LLC
Active
Organization
AMAZING GRACE PCA LLC
Active
Other names
Amazing Grace Personal Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DELPHENIA M LODIONG PHD (ADMINISTRATOR)
(907) 342-5608
Entity
Organization
Contact information
Practice address
182 ELLERSLIE DR, FAYETTEVILLE, NC 28303-5917
(907) 342-5608
Mailing address
182 ELLERSLIE DR, FAYETTEVILLE, NC 28303-5917
(907) 342-5608
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
07/04/2024
Last updated
07/04/2024
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