Organization
AMETHYST, INC.
Active
Other names
Amethyst, Inc. Medicaid MH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY L MOORE CPA (CHIEF FINANCIAL OFFICER)
(614) 242-1284
Entity
Organization
Contact information
Practice address
455 E MOUND ST, COLUMBUS, OH 43215-5595
(614) 242-1284
(614) 242-1286
Mailing address
455 E MOUND ST, COLUMBUS, OH 43215-5595
(614) 242-1284
(614) 242-1286
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2846620
—
OH
Enumeration date
06/11/2012
Last updated
06/11/2012
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