MEDICARE: AMAZING GRACE HOSPICE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1912518036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING GRACE HOSPICE INC.

Provider Business Mailing Address
First Line	:	921 LAS AVES PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 LAS AVES PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7326
Country	:	US
Telephone Number	:	915-587-4968
Fax Number	:

Authorized Official
Title or Position	:	CEO/ ADMINISTRATOR
Name	:	MICHAEL OYETUNDE
Credential	:
Telephone Number	:	915-587-4968

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	08/12/2020

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