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Organization

AMAZING GRACE REST HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. EARLEEN WELLMON (OWNER)
(704) 435-2952
Entity
Organization

Contact information

Practice address
3633 AMAZING GRACE RD, LAWNDALE, NC 28090-8407
(704) 435-2952
Mailing address
3633 AMAZING GRACE RD, LAWNDALE, NC 28090-8407
(704) 435-2952

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7802290
PROVIDER NUMBER
NC
Enumeration date
02/20/2007
Last updated
06/13/2008
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