MEDICARE: AMAZING GRACE HEALTHCARE SERVICES, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency		TX
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		TX

General Provider Information

NPI Number	:	1780700823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 710307
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77271-0307
Country	:	US
Telephone Number	:	281-403-3510
Fax Number	:	713-589-8778

Provider Business Practice Location Address
First Line	:	8449 W BELLFORT ST STE 285
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2246
Country	:	US
Telephone Number	:	281-403-3510
Fax Number	:	713-589-8778

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MICHAEL OKPAMEN
Credential	:
Telephone Number	:	281-403-3510

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	06/20/2024

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