Organization
INN AT THE AMETHYST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON HARDER (MANAGER)
(916) 485-8600
Entity
Organization
Contact information
Practice address
18172 N 91ST AVE, PEORIA, AZ 85382-3001
(623) 974-5847
Mailing address
3723 FAIRVIEW INDUSTRIAL DR SE STE 270, SALEM, OR 97302-4975
(916) 485-8600
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6408545
—
AZ
Enumeration date
03/25/2007
Last updated
08/22/2020
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