Provider Demographics
NPI:1528596095
Name:AMEN PROVIDER SERVICES INC
Entity Type:Organization
Organization Name:AMEN PROVIDER SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-854-4429
Mailing Address - Street 1:2611 N TEXAS BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-4062
Mailing Address - Country:US
Mailing Address - Phone:956-854-4429
Mailing Address - Fax:956-854-4432
Practice Address - Street 1:2611 N TEXAS BLVD STE 8
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-4062
Practice Address - Country:US
Practice Address - Phone:956-854-4429
Practice Address - Fax:956-854-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 3747P1801X
TX018296253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3944241-01Medicaid
TX018296OtherHCSSA
TX001029494Medicaid