=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497799738
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMAZING & BLESSED HOME HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 07/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 GREEN COVE LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75232-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-327-1100
-----------------------------------------------------
Fax | 214-327-1115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 GREEN COVE LN
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75232-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-327-1100
-----------------------------------------------------
Fax | 214-327-1115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHARON LOVE GUILLORY
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 972-374-8082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------