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General NPI Number Information
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NPI Number | 1265698955
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE ASSISTED LIVING
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 10543 FARMINGHAM DR
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City | HOUSTON
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State | TX
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Zip | 77099-3913
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Country | US
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Telephone | 281-564-3654
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Fax | 281-564-3654
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Provider Business Mailing Address
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Address Line | 10543 FARMINGHAM DR
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City | HOUSTON
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State | TX
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Zip | 77099-3913
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Country | US
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Telephone | 281-564-3654
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Fax | 281-564-3654
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GRACE ADA OKENDU I
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Credential | B.A ECONOMICS
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Telephone | 713-397-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011700
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License Number State | TX
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