Healthcare Provider Details

I. General information

NPI: 1003385758
Provider Name (Legal Business Name): A AMOR DE MADRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 WHITE RIVER PASS LN
SUGAR LAND TX
77479-3672
US

IV. Provider business mailing address

5923 WHITE RIVER PASS LN
SUGAR LAND TX
77479-3672
US

V. Phone/Fax

Practice location:
  • Phone: 318-243-3060
  • Fax:
Mailing address:
  • Phone: 318-243-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DEEPA GANGI
Title or Position: C.E.O.
Credential:
Phone: 318-243-3060