MEDICARE: AMAZING PEACE HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	138224	TX

General Provider Information

NPI Number	:	1407010036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING PEACE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1202 DONALDSON AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-4214
Country	:	US
Telephone Number	:	210-736-2305
Fax Number	:	210-736-0226

Provider Business Practice Location Address
First Line	:	1202 DONALDSON AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-4214
Country	:	US
Telephone Number	:	210-736-2305
Fax Number	:	210-736-0226

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CAROLINE CHIKWUE UZOH
Credential	:	RPH
Telephone Number	:	210-736-2305

Provider Enumeration Date	:	07/13/2008
Last Update Date	:	04/24/2015

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