Provider Demographics
NPI:1629803077
Name:AMEGO, INC.
Entity type:Organization
Organization Name:AMEGO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVINCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-541-1970
Mailing Address - Street 1:1435 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5315
Mailing Address - Country:US
Mailing Address - Phone:321-541-1970
Mailing Address - Fax:508-222-0503
Practice Address - Street 1:1435 AURORA RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5315
Practice Address - Country:US
Practice Address - Phone:321-541-1970
Practice Address - Fax:508-222-0503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEGO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty