Provider Demographics
NPI:1144805904
Name:AMBER HOUSE INC. HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:AMBER HOUSE INC. HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:AZALENE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BC
Authorized Official - Phone:414-702-5573
Mailing Address - Street 1:7414 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4746
Mailing Address - Country:US
Mailing Address - Phone:414-393-9922
Mailing Address - Fax:414-393-9923
Practice Address - Street 1:7414 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-4746
Practice Address - Country:US
Practice Address - Phone:414-393-9922
Practice Address - Fax:414-393-9923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBER HOUSE HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty