Community Services Contract - Provider AgreementCommunity Services Contract • January 24th, 2023
Name of Legal Entity (the “Contractor”)Amazing Home Care LLC Doing Business As (d/b/a) Name, if applicable Email Address of Contractor's Signature Authorityncubecatherine@hotmail.com Area Code and Telephone No.817-724-2576 Physical Address of Legal Entity (Street, City, State, ZIP Code)218 E Taylor Dr, Garland, TX 75040 Taxpayer ID. No. (EIN or SSN) 82-4331776 National Provider Identifier (NPI) or Atypical Provider Identifier (API)1972002640 Contract Effective Date (the "Begin Date")October 1, 2019 Contract Termination Date (the "End Date")March 31, 2022 Contract TypePrimary Home Care/Family Care/Community Attendant Services (PHC/FC/CAS) Contract No.Contract HHS000004900903: Provider #: 001031191 Service Area(s) (Region, Catchment Area or Waiver Contract Area)Region 3 Service Codes17, 17C, 17D Component Code (HCS, TxHmL, CDS-HCS and CDS-TxHmL only)N/A