Provider Demographics
NPI:1477381101
Name:AMITYPRO LLC
Entity type:Organization
Organization Name:AMITYPRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JALISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-817-6388
Mailing Address - Street 1:5473 BLAIR RD STE 870996
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4226
Mailing Address - Country:US
Mailing Address - Phone:855-564-6857
Mailing Address - Fax:
Practice Address - Street 1:5001 BRENTWOOD STAIR RD STE 202
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2800
Practice Address - Country:US
Practice Address - Phone:855-564-6857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care