Provider Demographics
NPI:1891928487
Name:AMAZING LIFE HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:AMAZING LIFE HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-884-4955
Mailing Address - Street 1:19141 STONE OAK PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3366
Mailing Address - Country:US
Mailing Address - Phone:210-884-4955
Mailing Address - Fax:
Practice Address - Street 1:21739 HARDY OAK BLVD
Practice Address - Street 2:5108
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2360
Practice Address - Country:US
Practice Address - Phone:210-884-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital