Healthcare Provider Details

I. General information

NPI: 1750334934
Provider Name (Legal Business Name): AMAZING GRACE NURSING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 BEECHNUT ST SUITE 120
HOUSTON TX
77036-6562
US

IV. Provider business mailing address

9720 BEECHNUT ST. SUITE 120
HOUSTON TX
77036-6654
US

V. Phone/Fax

Practice location:
  • Phone: 713-484-7555
  • Fax: 713-484-6318
Mailing address:
  • Phone: 713-484-7555
  • Fax: 713-484-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009098
License Number StateTX

VIII. Authorized Official

Name: TIAMIYU TAJUDEEN
Title or Position: ALT. ADMINISTRATOR
Credential:
Phone: 713-484-7555