# AMITY FELLOWSERVE OF MIDLAND, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AMITY FELLOWSERVE, INC.
- **Other names:** Kissito Healthcare Midland
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669771366
- **Legal business name:** AMITY FELLOWSERVE, INC.
- **Authorized official:** THOMAS CLARKE (CEO)
- **Authorized official phone:** (540) 265-0322

## Contact information

- **Practice address:** 3203 SAGE ST, MIDLAND, TX 79705-5711
- **Practice address phone:** (432) 683-5403
- **Practice address fax:** (432) 682-5105
- **Mailing address:** 5228 VALLEYPOINTE PKWY, BLDG. B, SUITE 1, ROANOKE, VA 24019-3074
- **Mailing address phone:** (540) 265-0322
- **Mailing address fax:** (540) 265-0305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 132737 | TX | Yes |

## Other

- **Enumeration date:** 03/21/2011
- **Last updated:** 11/22/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001019588 | — | TX |
| 01 | — | 004280 | FAC. ID | TX |