Amity Care, LLC
Organization Active NPI Community Based Hospice Care Agency · Marietta, GA
NPI 1942534722 · NPPES record last updated Jul 26, 2018
Key facts
- NPI
- 1942534722
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 29670 (GA)
- Legal business name
- AMITY CARE, LLC
- Practice address
- 161 Village Pkwy NE BLDG 7
Marietta, GA 30067 - Phone
- (678) 402-5235
- Fax
- (770) 818-5428
- NPI assigned
- Sep 25, 2009
- Organization subpart
- No
Authorized official
- Name
- Ahmad Ghadamyari
- Title
- Ceo
- Phone
- (678) 402-5235
Owners & managing parties with NPI records 2
-
Lee Wilkes, MD
Practitioners 6
-
Allie Edmiston, NP
-
Susanna Hammontree, GNP-BC, ANP-BC
-
Patricia Erin Weaver, FNP
-
Mya L Williams, APRN
Affiliated clinicians 1
-
Lee Wilkes, MD
Medicare Care Compare: Hospice
- Listed as
- Amity Care
- Ownership
- Other
- Certified
- Apr 1, 2010
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Hospice certification: CCN 111692
- Legal name
- AMITY CARE, LLC
- Doing business as
- AMITY CARE HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 1, 2010
- Last certification
- Dec 7, 2021
- Ownership / control type
- Other
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 24, 2008 in GA
- Enrollment address
- 161 Village Pkwy NE
BLDG 7
Marietta, GA 30067-4061
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Thomas John Demarco |
Contracted Managing Employee |
Apr 10, 2016 | 50% |
| Vickie N Ghadamyari |
W-2 Managing Employee |
Apr 22, 2015 | |
| Lee Wilkes |
Contracted Managing Employee |
Jan 1, 2018 | 50% |
| Ahmad Ghadamyari |
5% Or Greater Direct Ownership Interest | Sep 12, 2008 | 100% |
| W-2 Managing Employee |
Oct 24, 2008 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100107000645 | GA | Part a Provider - Hospice | 8224179650 | Practice locations: Marietta, GA |
| O20170424001741 | GA | Part B Supplier - Clinic/Group Practice | 8224179650 |
Receives reassigned benefits from 6 practitioners Practice locations: Marietta, GA |
National Provider Directory
Locations
161 Village Pkwy NE
#7
Marietta, GA 30067
Phone (678) 402-5235
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 29670 | GA | Yes |
Addresses
Primary practice location
161 Village Pkwy NE BLDG 7
Marietta, GA 30067
Mailing address
161 Village Pkwy NE BLDG 7
Marietta, GA 30067-4061
Phone (678) 402-5235
Other providers in Marietta, GA
- Ami Kirit Amin
- Sona P Amin
- Tarak Amin
- Candice Aming
- Camellia Aminzadeh
- Amore Group, Inc.
- Jason Lee Amos
- Ampt
- Yvonne Yvette Amstutz
- Indu Stacey Anand
All providers in Marietta, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.