Healthcare Provider Details

I. General information

NPI: 1487921367
Provider Name (Legal Business Name): AMISTAD ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 DEL RIO BLVD
EAGLE PASS TX
78852-3216
US

IV. Provider business mailing address

2431 DEL RIO BLVD
EAGLE PASS TX
78852-3216
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-8610
  • Fax:
Mailing address:
  • Phone: 830-773-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. RUBEN CARRILLO
Title or Position: DIRECTOR
Credential:
Phone: 830-776-0524