Amazing Grace Care Homes, Incesident

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

511482 Issued in OR

Legal business name

AMAZING GRACE CARE HOMES, INCESIDENT

Practice address

1205 Barnes Ave SE
Salem, OR 97306-1539

Phone

(503) 999-8159

NPI assigned

Feb 4, 2017

Last updated

Feb 4, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sherri M Jemison

Title

President

Phone

(503) 999-8159

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486166400000",
    "number": "1376081810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6995 SW NYBERG ST",
            "address_2": "SUITE X201",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970627455",
            "telephone_number": "503-999-8159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 BARNES AVE SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973061539",
            "telephone_number": "503-999-8159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE CARE HOMES, INCESIDENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-04",
        "last_updated": "2017-02-04",
        "status": "A",
        "authorized_official_last_name": "JEMISON",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-999-8159"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "OR",
            "license": "511482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARION COUNTY MENTAL HEALTH AFC PROVIDER",
            "identifier": "500500049",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Behavioral Disturbances) in Salem, OR
• Providers in Salem, OR by specialty
• Assisted Living Facility (Behavioral Disturbances) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.