Provider Demographics
NPI:1609690346
Name:1ST AMAPAC CO
Entity type:Organization
Organization Name:1ST AMAPAC CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:AWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-808-2148
Mailing Address - Street 1:4209 COBBLESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1673
Mailing Address - Country:US
Mailing Address - Phone:817-808-2148
Mailing Address - Fax:
Practice Address - Street 1:4209 COBBLESTONE CIR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1673
Practice Address - Country:US
Practice Address - Phone:817-808-2148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care