Provider Demographics
NPI:1386654374
Name:AMIGOS CRISTIANOS LLC
Entity Type:Organization
Organization Name:AMIGOS CRISTIANOS LLC
Other - Org Name:TEXAS STATE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:FODRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-743-2217
Mailing Address - Street 1:3211 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-7105
Mailing Address - Country:US
Mailing Address - Phone:979-323-7099
Mailing Address - Fax:979-323-0555
Practice Address - Street 1:3211 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-7105
Practice Address - Country:US
Practice Address - Phone:979-323-7099
Practice Address - Fax:979-323-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012139251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215202701Medicaid
TX679461Medicare Oscar/Certification
TX679461Medicare PIN