Organization
GRACE AND AMAZING COMFORT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAMEZI OLOKOR (MANAGER)
(772) 301-9461
Entity
Organization
Contact information
Practice address
4602 SW SCANAVINO ST, PORT SAINT LUCIE, FL 34953-6785
(772) 301-9461
(772) 405-2798
Mailing address
4602 SW SCANAVINO ST, PORT SAINT LUCIE, FL 34953-6785
(772) 301-9461
(772) 405-2798
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
03/21/2025
Last updated
03/21/2025
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