Provider Demographics
NPI:1003894841
Name:AMITY FELLOWSERVE INC.
Entity Type:Organization
Organization Name:AMITY FELLOWSERVE INC.
Other - Org Name:PALM VIEW REHABILITATION & CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-265-0322
Mailing Address - Street 1:2222 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8315
Mailing Address - Country:US
Mailing Address - Phone:928-783-8831
Mailing Address - Fax:928-782-5370
Practice Address - Street 1:2222 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8315
Practice Address - Country:US
Practice Address - Phone:928-783-8831
Practice Address - Fax:928-782-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXLTC00031Medicaid
AZ374108Medicaid
AZ374108Medicaid