Provider Demographics
NPI:1417969247
Name:AMISTAD FAMILY SERVICES
Entity type:Organization
Organization Name:AMISTAD FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW #24298
Authorized Official - Phone:830-734-0191
Mailing Address - Street 1:210 WHITE FEATHER TRL
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2028
Mailing Address - Country:US
Mailing Address - Phone:830-734-0191
Mailing Address - Fax:830-775-8933
Practice Address - Street 1:210 WHITE FEATHER TRL
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2028
Practice Address - Country:US
Practice Address - Phone:830-734-0191
Practice Address - Fax:830-775-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLBSW #24298302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization