Healthcare Provider Details

I. General information

NPI: 1003894841
Provider Name (Legal Business Name): AMITY FELLOWSERVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S AVENUE A
YUMA AZ
85364-8315
US

IV. Provider business mailing address

2222 S AVENUE A
YUMA AZ
85364-8315
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-8831
  • Fax: 928-782-5370
Mailing address:
  • Phone: 928-783-8831
  • Fax: 928-782-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS CLARKE
Title or Position: PRESIDENT
Credential:
Phone: 540-265-0322