Provider Demographics
NPI:1689062275
Name:AMP, LLC
Entity Type:Organization
Organization Name:AMP, LLC
Other - Org Name:ENTRUSTED PEDIATRIC HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-455-7476
Mailing Address - Street 1:111 W ANDERSON LN STE E322
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1146
Mailing Address - Country:US
Mailing Address - Phone:512-532-4800
Mailing Address - Fax:512-735-2061
Practice Address - Street 1:275 W CAMPBELL RD STE 255
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3784
Practice Address - Country:US
Practice Address - Phone:469-827-7500
Practice Address - Fax:512-793-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345177501Medicaid