Provider Demographics
NPI:1669842159
Name:AMISTAD CHILDRENS SERVICES
Entity Type:Organization
Organization Name:AMISTAD CHILDRENS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF DEVELOPMENTCOORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-657-0249
Mailing Address - Street 1:9241 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5503
Mailing Address - Country:US
Mailing Address - Phone:361-657-0249
Mailing Address - Fax:361-657-0250
Practice Address - Street 1:9241 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5503
Practice Address - Country:US
Practice Address - Phone:361-657-0249
Practice Address - Fax:361-657-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities