Provider Demographics
NPI:1790172641
Name:AMISTAD MILESTONES LLC
Entity Type:Organization
Organization Name:AMISTAD MILESTONES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-523-2288
Mailing Address - Street 1:3100 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005
Mailing Address - Country:US
Mailing Address - Phone:575-523-2288
Mailing Address - Fax:575-523-2299
Practice Address - Street 1:3100 OAK STREET
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-523-2288
Practice Address - Fax:575-523-2299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMISTAD FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty