Provider Demographics
NPI:1992791123
Name:AMISTAD HOMECARE, INC
Entity type:Organization
Organization Name:AMISTAD HOMECARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-474-0037
Mailing Address - Street 1:613 NW LOOP 410 STE 630
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5507
Mailing Address - Country:US
Mailing Address - Phone:210-474-0037
Mailing Address - Fax:210-474-0067
Practice Address - Street 1:613 NW LOOP 410 STE 630
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5507
Practice Address - Country:US
Practice Address - Phone:210-474-0037
Practice Address - Fax:210-474-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008287251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161734201Medicaid
TX161734201Medicaid