Provider Demographics
NPI:1902257066
Name:AMAZING GRACE PALLIATIVE AND HOSPICE CARE LLC
Entity Type:Organization
Organization Name:AMAZING GRACE PALLIATIVE AND HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-6220
Mailing Address - Street 1:849 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5556
Mailing Address - Country:US
Mailing Address - Phone:972-763-6220
Mailing Address - Fax:877-600-2919
Practice Address - Street 1:107 ROBIN LN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4774
Practice Address - Country:US
Practice Address - Phone:972-763-6220
Practice Address - Fax:877-600-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based