Provider Demographics
NPI:1740266865
Name:AMITY FELLOWSERVE OF KARNES CITY, INC.
Entity type:Organization
Organization Name:AMITY FELLOWSERVE OF KARNES CITY, 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 1:209 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:KARNES
Mailing Address - State:TX
Mailing Address - Zip Code:78118
Mailing Address - Country:US
Mailing Address - Phone:830-780-2426
Mailing Address - Fax:830-780-4248
Practice Address - Street 1:209 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:KARNES
Practice Address - State:TX
Practice Address - Zip Code:78118
Practice Address - Country:US
Practice Address - Phone:830-780-2426
Practice Address - Fax:830-780-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10033358Medicaid
455702Medicare ID - Type Unspecified