Healthcare Provider Details

I. General information

NPI: 1336550912
Provider Name (Legal Business Name): AMBER KINSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 FOREST HILL BLVD APT 1
EAST CLEVELAND OH
44112
US

IV. Provider business mailing address

1848 FOREST HILLS BLVD APT 1
EAST CLEVELAND OH
44112-4390
US

V. Phone/Fax

Practice location:
  • Phone: 216-370-0225
  • Fax:
Mailing address:
  • Phone: 216-370-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number400706780108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: