Provider Demographics
NPI:1699753301
Name:AMITY FELLOWSERVE OF KATY, INC.
Entity type:Organization
Organization Name:AMITY FELLOWSERVE OF KATY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-265-0322
Mailing Address - Street 1:5129 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2117
Mailing Address - Country:US
Mailing Address - Phone:281-391-7087
Mailing Address - Fax:281-391-8301
Practice Address - Street 1:5129 E 5TH ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2117
Practice Address - Country:US
Practice Address - Phone:281-391-7087
Practice Address - Fax:281-391-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675775Medicare ID - Type Unspecified