Provider Demographics
NPI:1508146242
Name:AMAZING LIFE CARE, LLC
Entity Type:Organization
Organization Name:AMAZING LIFE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/PART-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-917-1115
Mailing Address - Street 1:159 EVANSTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-1613
Mailing Address - Country:US
Mailing Address - Phone:903-917-1115
Mailing Address - Fax:
Practice Address - Street 1:159 EVANSTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-1613
Practice Address - Country:US
Practice Address - Phone:903-917-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities