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Organization
AMETHYST CARE HOME LLC
Active
Organization
AMETHYST CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROLANDO MANAGO (MANAGING MEMBER)
(702) 807-7634
Entity
Organization
Contact information
Practice address
3702 INTERNET AVE, NORTH LAS VEGAS, NV 89031-4160
(702) 702-4854
Mailing address
4150 CACKLING GOOSE DR, NORTH LAS VEGAS, NV 89084-2650
(702) 807-7634
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8642-AGC-0
DPBH
NV
Enumeration date
06/12/2019
Last updated
06/12/2019
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