Healthcare Provider Details

I. General information

NPI: 1174125405
Provider Name (Legal Business Name): AMITY NURSING AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RANDOLPH CT APT 201
FAIRFIELD OH
45014-4381
US

IV. Provider business mailing address

4 RANDOLPH CT APT 201
FAIRFIELD OH
45014-4381
US

V. Phone/Fax

Practice location:
  • Phone: 513-244-2600
  • Fax:
Mailing address:
  • Phone: 513-244-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CYRINUS SENGKA
Title or Position: OWNER
Credential:
Phone: 513-344-2600