Provider Demographics
NPI:1649504036
Name:AMERISA, INC.
Entity type:Organization
Organization Name:AMERISA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-591-0016
Mailing Address - Street 1:313 N. LEE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-7904
Mailing Address - Country:US
Mailing Address - Phone:806-336-6554
Mailing Address - Fax:
Practice Address - Street 1:313 N. LEE
Practice Address - Street 2:SUTIE B
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-7904
Practice Address - Country:US
Practice Address - Phone:806-591-0016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67-2080314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675280Medicare Oscar/Certification