Provider Demographics
NPI:1831442284
Name:A.M.E.N. HCS
Entity type:Organization
Organization Name:A.M.E.N. HCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-688-4734
Mailing Address - Street 1:1101 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3725
Mailing Address - Country:US
Mailing Address - Phone:361-434-5107
Mailing Address - Fax:361-334-3652
Practice Address - Street 1:1101 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3725
Practice Address - Country:US
Practice Address - Phone:361-434-5107
Practice Address - Fax:361-334-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2500000320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2500000Medicaid