Amazing Grace Home Health Agency Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

009677 Issued in TX

Legal business name

AMAZING GRACE HOME HEALTH AGENCY INC

Practice address

383 Perry Ave
Lewisville, TX 75057-3833

Phone

(972) 436-5241

Fax

(972) 436-5709

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Sunny Stephen Ugochukwu, PHD

Title

Chairman Ceo

Phone

(972) 436-5241

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Home health agency certification: CCN 679452

Legal name

AMAZING GRACE HOME HEALTH AGENCY INC

Doing business as

AMAZING GRACE HOME HEALTH AGENCY

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Mar 23, 2004

Last certification

Oct 1, 2018

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Apr 1, 2005 in TX

Enrollment address

383 Perry Street
Lewisville, TX 75057

Listed as

Amazing Grace Home Health Agency IncCCN 679452

Ownership

Proprietary

Certified

Mar 23, 2004

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431388800000",
    "number": "1457458440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 PERRY AVE",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573833",
            "telephone_number": "972-436-5241",
            "fax_number": "972-436-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 PERRY AVE",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750573833",
            "telephone_number": "972-436-5241",
            "fax_number": "972-436-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE HOME HEALTH AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-05-12",
        "status": "A",
        "authorized_official_last_name": "UGOCHUKWU",
        "authorized_official_first_name": "SUNNY",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "CHAIRMAN CEO",
        "authorized_official_telephone_number": "972-436-5241",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "009677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009677",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.