Provider Demographics
NPI:1093463309
Name:AMAZING FAITH LIVING & WELLNESS LLC
Entity Type:Organization
Organization Name:AMAZING FAITH LIVING & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:346-516-6503
Mailing Address - Street 1:2401 FOUNTAIN VIEW DR STE 312
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4819
Mailing Address - Country:US
Mailing Address - Phone:346-516-6503
Mailing Address - Fax:
Practice Address - Street 1:4717 PARADISE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-1027
Practice Address - Country:US
Practice Address - Phone:346-516-6502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances