Provider Demographics
NPI:1750334934
Name:AMAZING GRACE NURSING SERVICES, INC
Entity type:Organization
Organization Name:AMAZING GRACE NURSING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIAMIYU
Authorized Official - Middle Name:
Authorized Official - Last Name:TAJUDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-484-7555
Mailing Address - Street 1:9720 BEECHNUT ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-6654
Mailing Address - Country:US
Mailing Address - Phone:713-484-7555
Mailing Address - Fax:713-484-6318
Practice Address - Street 1:9720 BEECHNUT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-6562
Practice Address - Country:US
Practice Address - Phone:713-484-7555
Practice Address - Fax:713-484-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009098251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673136Medicare ID - Type UnspecifiedHOME HEALTH AGENCY