Provider Demographics
NPI:1689248601
Name:AMAZING LIGHT HOSPICE INC
Entity Type:Organization
Organization Name:AMAZING LIGHT HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OYETUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:915-867-9391
Mailing Address - Street 1:921 LAS AVES PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7326
Mailing Address - Country:US
Mailing Address - Phone:915-587-4968
Mailing Address - Fax:
Practice Address - Street 1:921 LAS AVES PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7326
Practice Address - Country:US
Practice Address - Phone:915-587-4968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based