Organization
AMITY FELLOWSERVE OF MIDLAND, INC.
Active
Parent organization
AMITY FELLOWSERVE, INC.
Other names
Kissito Healthcare Midland
Organization subpart
Yes
Provider details
NPI number
Legal business name
AMITY FELLOWSERVE, INC.
Authorized official
THOMAS CLARKE (CEO)
(540) 265-0322
Entity
Organization
Contact information
Practice address
3203 SAGE ST, MIDLAND, TX 79705-5711
(432) 683-5403
(432) 682-5105
Mailing address
5228 VALLEYPOINTE PKWY, BLDG. B, SUITE 1, ROANOKE, VA 24019-3074
(540) 265-0322
(540) 265-0305
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
132737
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001019588
—
TX
01
—
004280
FAC. ID
TX
Enumeration date
03/21/2011
Last updated
11/22/2011
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