Provider Demographics
NPI:1275070567
Name:AMAZING GRACE ENTERPRISES, INC
Entity Type:Organization
Organization Name:AMAZING GRACE ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-796-4900
Mailing Address - Street 1:103 RIO RANCHO DR NE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1439
Mailing Address - Country:US
Mailing Address - Phone:505-796-4900
Mailing Address - Fax:505-896-4515
Practice Address - Street 1:103 RIO RANCHO DR NE
Practice Address - Street 2:SUITE A-2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1439
Practice Address - Country:US
Practice Address - Phone:505-796-4900
Practice Address - Fax:505-896-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty