Provider Demographics
NPI:1417948381
Name:AMERISA,INC.
Entity Type:Organization
Organization Name:AMERISA,INC.
Other - Org Name:TUMBLEWEED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-438-0266
Mailing Address - Street 1:1101 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-3811
Mailing Address - Country:US
Mailing Address - Phone:806-637-7561
Mailing Address - Fax:806-637-6230
Practice Address - Street 1:1101 E LAKE ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3811
Practice Address - Country:US
Practice Address - Phone:806-637-7561
Practice Address - Fax:806-637-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111061313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015174Medicaid
TX001015174Medicaid