Provider Demographics
NPI:1275797599
Name:AMISTAD PRIMARY HOME CARE, INC.
Entity Type:Organization
Organization Name:AMISTAD PRIMARY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-624-3609
Mailing Address - Street 1:409 DOVE AVE.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-624-3609
Mailing Address - Fax:
Practice Address - Street 1:119 N. 9TH 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:956-383-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty