Healthcare Provider Details

I. General information

NPI: 1639796410
Provider Name (Legal Business Name): AMENITY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W LAKE ST STE 202
ADDISON IL
60101-2082
US

IV. Provider business mailing address

715 W LAKE ST STE 202
ADDISON IL
60101-2082
US

V. Phone/Fax

Practice location:
  • Phone: 630-366-6424
  • Fax: 630-366-6550
Mailing address:
  • Phone: 630-366-6424
  • Fax: 630-366-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHALINI LIYANAPATABENDI
Title or Position: OWNER
Credential:
Phone: 630-366-6424