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General NPI Number Information
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NPI Number | 1780088336
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Entity Type | Organization
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Legal Business Name | AMISTAD PHC,L.L.C.
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 4814 N 11TH ST STE D
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City | MCALLEN
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State | TX
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Zip | 78504-3625
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Country | US
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Telephone | 956-627-3970
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Fax | 956-627-3975
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Provider Business Mailing Address
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Address Line | 4814 N 11TH ST STE D
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City | MCALLEN
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State | TX
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Zip | 78504-3625
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Country | US
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Telephone | 956-627-3970
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Fax | 956-627-3975
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SILVIA M GOMEZ
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Credential |
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Telephone | 956-627-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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