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General NPI Number Information
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NPI Number | 1093463309
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Entity Type | Organization
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Legal Business Name | AMAZING FAITH LIVING & WELLNESS LLC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 4717 PARADISE LN
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City | HOUSTON
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State | TX
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Zip | 77048-1027
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Country | US
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Telephone | 346-516-6502
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 FOUNTAIN VIEW DR STE 312
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City | HOUSTON
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State | TX
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Zip | 77057-4819
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Country | US
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Telephone | 346-516-6503
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | MS. PAMELA ROBERSON
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Credential | DRPH
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Telephone | 346-516-6503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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