MEDICARE: AMAZING AMITY HOMECARE AGENCY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1619506078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING AMITY HOMECARE AGENCY CORPORATION

Provider Business Mailing Address
First Line	:	2310 SAN MARCOS DR
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-1010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 SAN MARCOS DR
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-1010
Country	:	US
Telephone Number	:	713-992-7810
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSAN NJERI WANJIRU
Credential	:
Telephone Number	:	713-992-7810

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	01/14/2024

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