Provider Demographics
NPI:1356397301
Name:AMARILLO MULTISERVICE CENTER FOR THE AGING, INC.
Entity type:Organization
Organization Name:AMARILLO MULTISERVICE CENTER FOR THE AGING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN (KRISSY)
Authorized Official - Middle Name:R
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-374-5516
Mailing Address - Street 1:3108 S. FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-1026
Mailing Address - Country:US
Mailing Address - Phone:806-374-5516
Mailing Address - Fax:806-373-9446
Practice Address - Street 1:3108 S. FILLMORE ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-1026
Practice Address - Country:US
Practice Address - Phone:806-374-5516
Practice Address - Fax:806-373-9446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMARILLO MULTISERVICE CENTER FOR THE AGING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003308261QA0600X
TX116635251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH4517OtherCMS H NUMBER
TX00330800OtherDAHS CONTRACT
TX001012340OtherPACE CONTRACT