Provider Demographics
NPI:1275044299
Name:AMENITY HOME CARE INC
Entity Type:Organization
Organization Name:AMENITY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:MEDINAT
Authorized Official - Last Name:OLADIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-537-7621
Mailing Address - Street 1:12045 BODLEY PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-3714
Mailing Address - Country:US
Mailing Address - Phone:317-537-7621
Mailing Address - Fax:317-559-7169
Practice Address - Street 1:12045 BODLEY PL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-3714
Practice Address - Country:US
Practice Address - Phone:317-537-7621
Practice Address - Fax:317-559-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17014010-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN17014010-1OtherPERSONAL SERVICES AGENCY LICENSE