# AMETHYST CARE HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346809373
- **Authorized official:** ROLANDO MANAGO (MANAGING MEMBER)
- **Authorized official phone:** (702) 807-7634

## Contact information

- **Practice address:** 3702 INTERNET AVE, NORTH LAS VEGAS, NV 89031-4160
- **Practice address phone:** (702) 702-4854
- **Mailing address:** 4150 CACKLING GOOSE DR, NORTH LAS VEGAS, NV 89084-2650
- **Mailing address phone:** (702) 807-7634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/12/2019
- **Last updated:** 06/12/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8642-AGC-0 | DPBH | NV |