MEDICARE: AMENITY HOSPICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	010588	TX

General Provider Information

NPI Number	:	1679681233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMENITY HOSPICE, INC

Provider Business Mailing Address
First Line	:	PO BOX 638
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-0031
Country	:	US
Telephone Number	:	956-361-5100
Fax Number	:	956-361-5106

Provider Business Practice Location Address
First Line	:	625 N SAM HOUSTON BLVD
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-4670
Country	:	US
Telephone Number	:	956-361-5100
Fax Number	:	956-361-5106

Authorized Official
Title or Position	:	PRESIDENT- CEO
Name	:	MS. ROSALINDA HERNANDEZ
Credential	:	LVN
Telephone Number	:	956-361-5100

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/10/2007

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