AMETHYST CARE HOME LLC (NPI# 1346809373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346809373 |
| Entity Type | Organization |
| Organization Name | AMETHYST CARE HOME LLC |
| Practice Address |
3702 Internet Ave North Las Vegas NV 89031-4160 |
| Mailing Address |
4150 Cackling Goose Dr North Las Vegas NV 89084-2650 |
| Practice Telephone | 7027024854 |
| Mailing Telephone | 7028077634 |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-06-12 |
| Authorized Official Name | ROLANDO MANAGO (MANAGING MEMBER) |
| Authorized Official Telephone | 7028077634 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | DPBH | 8642-AGC-0 | 01 |
| Street Address |
3702 INTERNET AVE |
| City | NORTH LAS VEGAS |
| State | NV |
| Zip Code | 89031-4160 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265071039 | Dimuro Facilities Services | Pain Medicine | Dimuro Pain Management, 3970 W Ann Road Ste 100, N Las Vegas, NV 89031 | 2019-12-27 |
| 1225681323 | Jasmine Coleman | Home Health Aide | 1517 Santa Rosalia Dr., North Las Vegas, NV 89031 | 2019-07-18 |
| 1558924134 | Jamie Esprecion | Driver | 3007 Extravagant Ave, North Las Vegas, NV 89031 | 2019-04-18 |
| 1831652387 | Assured Medical Supply, Inc. | Durable Medical Equipment & Medical Supplies | 4461 North Decatur Blvd, Ste 110, N Las Vegas, NV 89031 | 2019-04-11 |
| 1265928550 | Geraldine Alford | Chore Provider | 5150 El Camino Norte Suite 150, Las Vegas, NV 89031 | 2018-07-10 |
| 1861999468 | Danielle Anderson | Counselor | 4528 West Craig Suite 150, Las Vegas, NV 89031 | 2018-04-10 |
| 1871094078 | Ethel Richardson | Chore Provider | 620 Manuel Edwardo Ave, N. Las Vegas, NV 89031 | 2018-02-22 |
| 1124547997 | Crystal Dorin Mcdowell | Counselor | 5920 Palmilla St Unit 5, North Las Vegas, NV 89031 | 2017-09-13 |
| 1699293308 | Mitzi Darnell Adeyemi | Counselor | 2205 Mountain Sunset Ave, North Las Vegas, NV 89031 | 2017-09-01 |
| 1831629500 | Emily Davis | Case Manager/Care Coordinator | 1926 La Villa Dr, North Las Vegas, NV 89031 | 2017-06-15 |
| Find all providers in zip 89031 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811535461 | Adult Comfort and Care Home LLC | Custodial Care Facility | 2105 Carroll St, North Las Vegas, NV 89030-6483 | 2019-12-13 |
| 1578047429 | Holy Angel Care Home, LLC | Custodial Care Facility | 1517 Gentle Brook St, North Las Vegas, NV 89084-2031 | 2018-09-17 |
| 1053827212 | A Precious Gems LLC | Custodial Care Facility | 1733 Hunters Bluff Dr, North Las Vegas, NV 89032-7983 | 2017-12-22 |
| 1942665922 | Timeless Individual Residential Care | Custodial Care Facility | 4617 Santa Monica Ave, North Las Vegas, NV 89032-2831 | 2015-12-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
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| 1902444557 | Adult Care Home LLC | Custodial Care Facility | 10315 Queensbury Ave, Las Vegas, NV 89135-2132 | 2019-12-13 |
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| 1497391635 | Sunlight Garden Group LLC | Custodial Care Facility | 950 Garden Breeze Way, Las Vegas, NV 89123-3630 | 2019-11-22 |
| 1922644459 | Golden Years Residential Care Facility, LLC | Custodial Care Facility | 8920 Loggers Mill Ave, Las Vegas, NV 89143-5423 | 2019-11-19 |
| 1114562667 | Longevity Residential Care II | Custodial Care Facility | 4073 Kings Row, Reno, NV 89503-6825 | 2019-11-07 |
| 1326682667 | Golden Sunshine Alzheimer's Home Care, Inc. | Custodial Care Facility | 7765 Clearwood Ave, Las Vegas, NV 89123-0301 | 2019-10-30 |
| 1902457021 | At Nightingales LLC | Custodial Care Facility | 813 Fairway Dr, Las Vegas, NV 89107-2012 | 2019-09-20 |
| 1104485481 | Silverado Ranch Memory Care, Inc. | Custodial Care Facility | 248 Barletta Ave, Las Vegas, NV 89123-7410 | 2019-06-10 |
| Find all providers with the same taxonomy | ||||
| City | NORTH LAS VEGAS |
| Zip Code | 89031 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.