Provider Demographics
NPI:1174388805
Name:AMAZING GRACE MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:AMAZING GRACE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NGAM AGBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-340-5313
Mailing Address - Street 1:1472 N HAMPTON RD STE 100D
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3001
Mailing Address - Country:US
Mailing Address - Phone:469-340-5313
Mailing Address - Fax:
Practice Address - Street 1:1472 N HAMPTON RD STE 100D
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3001
Practice Address - Country:US
Practice Address - Phone:469-340-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies