Provider Demographics
NPI:1003813908
Name:AMENITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:AMENITY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5078
Mailing Address - Country:US
Mailing Address - Phone:615-425-5407
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:5005 BOWLING ST SW STE B
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5070
Practice Address - Country:US
Practice Address - Phone:319-362-2500
Practice Address - Fax:319-362-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IASTATE DOES NOT ISSUE251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7251528OtherAETNA
IA0615716Medicaid
IA61566OtherWELLMARK BCBS
IA161566Medicare ID - Type UnspecifiedMEDICARE PROVIDER #