Healthcare Provider Details

I. General information

NPI: 1124634399
Provider Name (Legal Business Name): AMBER HOUSE STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SUMMIT AVE STE 4
GREENSBORO NC
27405-7746
US

IV. Provider business mailing address

611 SUMMIT AVE STE 4
GREENSBORO NC
27405-7746
US

V. Phone/Fax

Practice location:
  • Phone: 336-285-5052
  • Fax: 336-285-5135
Mailing address:
  • Phone: 336-285-5052
  • Fax: 336-285-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: AMBER HALL
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 336-285-5052