Amistad of San Luis, Inc

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

AMISTAD OF SAN LUIS, INC

Practice address

403 Main Street
San Luis, CO 81152-0674

Phone

(719) 672-0892

Fax

(719) 672-0892

NPI assigned

Feb 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Judith Ann Funk

Title

Owner/Director

Phone

(719) 588-9903

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1831557917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 MAIN STREET",
            "address_2": "P.O.BOX 674",
            "city": "SAN LUIS",
            "state": "CO",
            "postal_code": "811520674",
            "telephone_number": "719-672-0892",
            "fax_number": "719-672-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 MAIN STREET",
            "city": "SAN LUIS",
            "state": "CO",
            "postal_code": "811520674",
            "telephone_number": "719-672-0892",
            "fax_number": "719-672-0892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMISTAD OF SAN LUIS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-04",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "FUNK",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "719-588-9903",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68058217",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Centenial School District R1
• Costilla County Ambulance District
• Costilla County Ambulance District
• County of Costilla
• County of Costilla

• Adult Day Care Clinic/Center in San Luis, CO
• Providers in San Luis, CO by specialty
• Adult Day Care Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.