Organization
AMETHYST HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DELONG (EXECUTIVE DIRECTOR)
(812) 336-3570
Entity
Organization
Contact information
Practice address
645 N WALNUT ST, BLOOMINGTON, IN 47404-3846
(812) 336-3570
(812) 336-9010
Mailing address
PO BOX 11, BLOOMINGTON, IN 47402-0011
(812) 336-3570
(812) 336-9010
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
1279-0 ASR
IN
324500000X
Substance Abuse Rehabilitation Facility
Primary
1279-0 CA
IN
Other
Enumeration date
04/17/2007
Last updated
09/26/2011
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