Healthcare Provider Details

I. General information

NPI: 1275122079
Provider Name (Legal Business Name): AMBER KEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 SHERATON DR NW
NORTH CANTON OH
44720-2271
US

IV. Provider business mailing address

259 SHERATON DR NW
NORTH CANTON OH
44720-2271
US

V. Phone/Fax

Practice location:
  • Phone: 330-605-1527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: