Provider Demographics
NPI:1316994114
Name:AMBER HOUSE, INC.
Entity type:Organization
Organization Name:AMBER HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-388-9964
Mailing Address - Street 1:213 WOODHILL CT
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4773
Mailing Address - Country:US
Mailing Address - Phone:507-388-9964
Mailing Address - Fax:507-388-2426
Practice Address - Street 1:317 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6713
Practice Address - Country:US
Practice Address - Phone:507-344-0209
Practice Address - Fax:350-734-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1005205311ZA0620X
MN1005246320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities