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General NPI Number Information
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NPI Number | 1164638565
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE PERSONAL CARE SERVICE, INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 4131 BARBARA LOOP SE # 2D
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City | RIO RANCHO
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State | NM
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Zip | 87124-1362
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Country | US
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Telephone | 505-796-4900
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Fax | 505-896-4513
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Provider Business Mailing Address
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Address Line | 4131 BARBARA LOOP SE # 2D
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City | RIO RANCHO
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State | NM
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Zip | 87124-1362
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Country | US
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Telephone | 505-863-5898
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Fax | 505-896-4513
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Authorized Official
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Title or Position | OWNER
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Name | TOM CRIDER
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Credential | M. DIV
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Telephone | 505-796-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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