Provider Demographics
NPI:1134312101
Name:AMISTAD PROVIDER AGENCY, INC.
Entity Type:Organization
Organization Name:AMISTAD PROVIDER AGENCY, INC.
Other - Org Name:AMISTAD PROVIDER AGENCY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-318-3235
Mailing Address - Street 1:601 E MCINTYRE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541
Mailing Address - Country:US
Mailing Address - Phone:956-318-3235
Mailing Address - Fax:956-318-3240
Practice Address - Street 1:601 E MCINTYRE AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541
Practice Address - Country:US
Practice Address - Phone:956-318-3235
Practice Address - Fax:956-318-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012246251E00000X, 3747P1801X, 385H00000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X, 385H00000X, 385HR2055X, 385HR2060X, 385HR2065X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1854903-01Medicaid