Amazing Grace Personal Care Service, Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

AMAZING GRACE PERSONAL CARE SERVICE, INC

Practice address

4131 Barbara Loop SE # 2D
Rio Rancho, NM 87124-1362

Phone

(505) 796-4900

Fax

(505) 896-4513

NPI assigned

May 15, 2007

Last updated

Sep 27, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tom Crider, M. DIV

Title

Owner

Phone

(505) 796-4900

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1164638565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 BARBARA LOOP SE # 2D",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241362",
            "telephone_number": "505-863-5898",
            "fax_number": "505-896-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 BARBARA LOOP SE # 2D",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241362",
            "telephone_number": "505-796-4900",
            "fax_number": "505-896-4513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1613 South 2nd Street",
            "address_purpose": "LOCATION",
            "city": "Gallup",
            "state": "NM",
            "postal_code": "573015816",
            "country_code": "US",
            "telephone_number": "505-863-5898",
            "fax_number": "505-896-4513",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AMAZING GRACE PERSONAL CARE SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "CRIDER",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-796-4900",
        "authorized_official_credential": "M. DIV"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62985736",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Paul J Ameduri, MS, CMHC
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• Jherika J Anaya-Campos

• In Home Supportive Care Agency in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• In Home Supportive Care Agency in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.