Provider Demographics
NPI:1457458440
Name:AMAZING GRACE HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:AMAZING GRACE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:UGOCHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-436-5241
Mailing Address - Street 1:383 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3833
Mailing Address - Country:US
Mailing Address - Phone:972-436-5241
Mailing Address - Fax:972-436-5709
Practice Address - Street 1:383 PERRY AVE
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3833
Practice Address - Country:US
Practice Address - Phone:972-436-5241
Practice Address - Fax:972-436-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009677251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009677Medicaid
TX679452Medicare Oscar/Certification
TX009677Medicaid