Healthcare Provider Details

I. General information

NPI: 1952389660
Provider Name (Legal Business Name): AMITY FELLOWSERVE OF HONDO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 AVENUE Q
HONDO TX
78861
US

IV. Provider business mailing address

3002 AVENUE Q
HONDO TX
78861
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-3056
  • Fax: 830-426-4606
Mailing address:
  • Phone: 830-426-3056
  • Fax: 830-426-4606

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: MRS. GAIL GLASS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 540-265-0322