1912363664 NPI number — AMOROSA HEALTHCARE SERVICES, LLC

Table of content: (NPI 1912363664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912363664 NPI number — AMOROSA HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMOROSA HEALTHCARE SERVICES, LLC
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:
AMOROSA HEALTHCARE SERVICES
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:
1912363664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 E. REDBUD AVE.
Provider Second Line Business Mailing Address:
SUITE 17-C
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-272-1963
Provider Business Mailing Address Fax Number:
956-435-0134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E. REDBUD AVE.
Provider Second Line Business Practice Location Address:
SUITE 17-C
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-272-1963
Provider Business Practice Location Address Fax Number:
956-435-0134
Provider Enumeration Date:
01/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HORR
Authorized Official First Name:
GILDA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-683-1842

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32055344595 . This is a "TAXPAYER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3829624-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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