Provider Demographics
NPI:1952389660
Name:AMITY FELLOWSERVE OF HONDO, INC.
Entity Type:Organization
Organization Name:AMITY FELLOWSERVE OF HONDO, INC.
Other - Org Name:HONDO HEALTHCARE & REHABILITATION CENTER
Other - Org Type:Doing Business As
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 1:3002 AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861
Mailing Address - Country:US
Mailing Address - Phone:830-426-3056
Mailing Address - Fax:830-426-4606
Practice Address - Street 1:3002 AVENUE Q
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861
Practice Address - Country:US
Practice Address - Phone:830-426-3056
Practice Address - Fax:830-426-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
455534Medicare ID - Type Unspecified