=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609888627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMAZING HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1915 S AUSTIN AVE SUITE 104
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-7843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-864-9994
-----------------------------------------------------
Fax | 512-864-9954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1915 S AUSTIN AVE SUITE 104
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-7843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-864-9994
-----------------------------------------------------
Fax | 512-864-9954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT ADMINISTRATOR
-----------------------------------------------------
Name | MS. TANDY L STEEN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 512-864-9994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------