Provider Demographics
NPI:1194338681
Name:FORTALEZA Y AMISTAD PRIMARY HOME CARE, LLC.
Entity type:Organization
Organization Name:FORTALEZA Y AMISTAD PRIMARY HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-975-5208
Mailing Address - Street 1:1912 WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-3022
Mailing Address - Country:US
Mailing Address - Phone:956-975-5208
Mailing Address - Fax:956-517-1361
Practice Address - Street 1:1912 WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-3022
Practice Address - Country:US
Practice Address - Phone:956-975-5208
Practice Address - Fax:956-517-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty