Provider Demographics
NPI:1679866362
Name:MIS AMIGOS FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:MIS AMIGOS FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-461-3144
Mailing Address - Street 1:224 W ROUTE 66 BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-3257
Mailing Address - Country:US
Mailing Address - Phone:575-461-3144
Mailing Address - Fax:575-461-1852
Practice Address - Street 1:224 W ROUTE 66 BLVD
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3257
Practice Address - Country:US
Practice Address - Phone:575-461-3144
Practice Address - Fax:575-461-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5466251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services