MEDICARE: AMAZING GRACE OVER TEXAS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	177F00000X	Lodging Provider
3	251B00000X	Case Management Agency
4	253Z00000X	In Home Supportive Care Agency
5	251G00000X	Community Based Hospice Care Agency
6	253J00000X	Foster Care Agency
7	174200000X	Meals Provider
8	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1861330359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE OVER TEXAS LLC

Provider Business Mailing Address
First Line	:	7460 KITTY HAWK RD LOT 161
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2483
Country	:	US
Telephone Number	:	726-242-2639
Fax Number	:

Provider Business Practice Location Address
First Line	:	7460 KITTY HAWK RD LOT 161
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2483
Country	:	US
Telephone Number	:	727-242-2639
Fax Number	:

Authorized Official
Title or Position	:	OWNER/HR DIRECTOR/ CASE MANAGEMENT
Name	:	INDA TONEY GREEN
Credential	:
Telephone Number	:	726-242-2639

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	04/17/2026

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Directions to “AMAZING GRACE OVER TEXAS LLC ” Practice Location

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