Provider Demographics
NPI:1861238990
Name:AMAZING GRACE LIVING HOME HEALTH LLC
Entity type:Organization
Organization Name:AMAZING GRACE LIVING HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NGAM AGBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-901-4886
Mailing Address - Street 1:679 MAJESTIC OAK LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-9501
Mailing Address - Country:US
Mailing Address - Phone:469-901-4886
Mailing Address - Fax:214-602-4077
Practice Address - Street 1:679 MAJESTIC OAK LN
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-9501
Practice Address - Country:US
Practice Address - Phone:469-901-4886
Practice Address - Fax:214-602-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care