Contact

Home Care
Referral Form

Name: Amazing Home Care
Address: 1601 Bronxdale Ave 2nd Floor, Suite 207, Bronx, NY, 10462
Telephone: P: 718-863-3300

Live at home safely

If you or your loved ones are in need of home care services, Amazing Home Care can provide them with the care and treatment they need.

First Name*

Last Name*

Gender

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Female

Date of Birth

Primary Language

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone*

Alternate Telephone

Medicaid ID Number

First Name

Last Name

Relationship

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone

Alternate Telephone

Home About Services Eligibility Prepare for Care Careers Referrals Get Care FAQs Compliance

Contact E. info@amazinghc.com P: 718-863-3300 F: 718-863-4300

Office 1601 Bronxdale Ave
2nd Floor, Suite 207
Bronx, NY 10462

Connect

Amazing Home Care is part of the Centers Health Care network, the leader in post acute care in the Northeast.

Centers Health Care Corporate Site

Accredited and licensed by the New York State Department of Health and CMS