Provider Demographics
NPI:1730955618
Name:AMAZING GRACE HEALTH CARE LLC
Entity type:Organization
Organization Name:AMAZING GRACE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BINETTE
Authorized Official - Middle Name:FORZONG
Authorized Official - Last Name:FONGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-390-7313
Mailing Address - Street 1:5135 BRIDESHEAD CT
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3186
Mailing Address - Country:US
Mailing Address - Phone:202-390-7313
Mailing Address - Fax:
Practice Address - Street 1:5135 BRIDESHEAD CT
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3186
Practice Address - Country:US
Practice Address - Phone:202-390-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities