Provider Demographics
NPI: | 1902240294 |
---|---|
Name: | AMAZING HEARTS HOMECARE AND STAFFING LLC |
Entity type: | Organization |
Organization Name: | AMAZING HEARTS HOMECARE AND STAFFING LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TOSHA |
Authorized Official - Middle Name: | YVETTE |
Authorized Official - Last Name: | MOORE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 903-742-4139 |
Mailing Address - Street 1: | 601 S CLAY ST STE 107 |
Mailing Address - Street 2: | |
Mailing Address - City: | ENNIS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75119-5771 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-385-7111 |
Mailing Address - Fax: | 817-385-1637 |
Practice Address - Street 1: | 601 S CLAY ST STE 107 |
Practice Address - Street 2: | |
Practice Address - City: | ENNIS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75119-5771 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-385-7111 |
Practice Address - Fax: | 817-385-1637 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-04-17 |
Last Update Date: | 2025-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
163W00000X, 163WH0200X, 164X00000X, 225100000X, 225X00000X, 310400000X, 320900000X, 3747A0650X, 3747P1801X, 385HR2060X | ||
TX | 016140 | 251B00000X, 251E00000X, 251J00000X, 253Z00000X, 385H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | ||
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | |
No | 164X00000X | Nursing Service Providers | Licensed Vocational Nurse | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | ||
No | 251E00000X | Agencies | Home Health | ||
No | 251J00000X | Agencies | Nursing Care | ||
No | 253Z00000X | Agencies | In Home Supportive Care | Group - Multi-Specialty | |
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | Group - Multi-Specialty | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Multi-Specialty | |
No | 3747A0650X | Nursing Service Related Providers | Technician | Attendant Care Provider | Group - Multi-Specialty |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Multi-Specialty |
No | 385H00000X | Respite Care Facility | Respite Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 334738702 | Medicaid | |
TX | 334738701 | Medicaid |