| Organization Name: | LA AMISTAD PROVIDER SERVICES |
| NPI Number: | 1093163529 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FELIPITA BASTIDA (ADMINISTRATOR) |
| Mailing Address: | 401 N Monroe St Beeville |
| State: | TX US |
| Postal Code: | 781024433 |
| Phone Number: | 3613189015 |
| Fax Number: | 3613588058 |
| NPI Enumeration Date: | 05/25/2016 |
| NPI Last Update Date: | 05/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |