Provider Demographics
NPI:1467584482
Name:FAULKNER, AMBER L (HHA)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:L
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 MURIEL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3138
Mailing Address - Country:US
Mailing Address - Phone:216-398-9529
Mailing Address - Fax:
Practice Address - Street 1:4016 MURIEL AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3138
Practice Address - Country:US
Practice Address - Phone:216-398-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRW669234320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities