MEDICARE: AMBER HOUSE INC. HOME HEALTH AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1144805904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBER HOUSE INC. HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	7414 W HAMPTON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4746
Country	:	US
Telephone Number	:	414-393-9922
Fax Number	:	414-393-9923

Provider Business Practice Location Address
First Line	:	7414 W HAMPTON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4746
Country	:	US
Telephone Number	:	414-393-9922
Fax Number	:	414-393-9923

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CARMEN AZALENE MARTIN
Credential	:	RN-BC
Telephone Number	:	414-702-5573

Provider Enumeration Date	:	03/13/2021
Last Update Date	:	03/13/2021

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