Provider Demographics
NPI:1811215908
Name:AMAZING GRACE HOSPICE INC
Entity Type:Organization
Organization Name:AMAZING GRACE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOJY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-734-5659
Mailing Address - Street 1:4675 INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2428
Mailing Address - Country:US
Mailing Address - Phone:214-734-5659
Mailing Address - Fax:187-773-4565
Practice Address - Street 1:4675 INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2428
Practice Address - Country:US
Practice Address - Phone:214-734-5659
Practice Address - Fax:187-773-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based