# AMAZING GRACE PERSONAL CARE SERVICE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164638565
- **Authorized official:** TOM CRIDER M. DIV (OWNER)
- **Authorized official phone:** (505) 796-4900

## Contact information

- **Practice address:** 4131 BARBARA LOOP SE \# 2D, RIO RANCHO, NM 87124-1362
- **Practice address phone:** (505) 796-4900
- **Practice address fax:** (505) 896-4513
- **Mailing address:** 4131 BARBARA LOOP SE \# 2D, RIO RANCHO, NM 87124-1362
- **Mailing address phone:** (505) 863-5898
- **Mailing address fax:** (505) 896-4513

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |
| 3747P1801X | Personal Care Attendant | — | — | — |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 09/27/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 62985736 | — | NM |