1356397301 NPI number — AMARILLO MULTISERVICE CENTER FOR THE AGING, INC.

Table of content: (NPI 1356397301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356397301 NPI number — AMARILLO MULTISERVICE CENTER FOR THE AGING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMARILLO MULTISERVICE CENTER FOR THE AGING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JAN WERNER ADULT DAY CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356397301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3108 S. FILLMORE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79110-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-374-5516
Provider Business Mailing Address Fax Number:
806-373-9446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3108 S. FILLMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79110-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-374-5516
Provider Business Practice Location Address Fax Number:
806-373-9446
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HURT
Authorized Official First Name:
KRISTEN (KRISSY)
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
806-374-5516

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , with the licence number:  116635 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA0600X , with the licence number: 003308 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H4517 . This is a "CMS H NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00330800 . This is a "DAHS CONTRACT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001012340 . This is a "PACE CONTRACT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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