MEDICARE: AMAZING GRACE SYSTEMS HOME HEALTH,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	251E00000X	Home Health Agency	011021	TX

General Provider Information

NPI Number	:	1912190414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE SYSTEMS HOME HEALTH,LLC

Provider Business Mailing Address
First Line	:	921 LAS AVES PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7326
Country	:	US
Telephone Number	:	915-587-4968
Fax Number	:	915-581-0170

Provider Business Practice Location Address
First Line	:	921 LAS AVES PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7326
Country	:	US
Telephone Number	:	915-587-4968
Fax Number	:	915-581-0170

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL ADEMOLA OYETUNDE
Credential	:	NURSE RN
Telephone Number	:	915-587-4968

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	05/08/2026

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