AMETHYST HOUSE, INC. (NPI# 1770709230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770709230 |
| Entity Type | Organization |
| Organization Name | AMETHYST HOUSE, INC. |
| Practice Address |
645 N Walnut St Bloomington IN 47404-3846 |
| Mailing Address |
Po Box 11 Bloomington IN 47402-0011 |
| Practice Telephone | 8123363570 |
| Practice Fax Number | 8123369010 |
| Mailing Telephone | 8123363570 |
| Mailing Fax Number | 8123369010 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-09-26 |
| Authorized Official Name | MARK DELONG (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8123363570 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | 1279-0 ASR | IN | Agencies |
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 1279-0 CA | IN | Residential Treatment Facilities |
| Street Address |
645 N WALNUT ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47404-3846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760503718 | Mark Delong | Counselor | 645 N Walnut St, Bloomington, IN 47404-3846 | 2007-04-03 |
| 1669931341 | Amanda Adhami | Psychologist | 645 N Walnut St, Bloomington, IN 47404-3846 | 2019-03-13 |
| 1710432851 | James Flannery Walker | Social Worker | 645 N Walnut St, Bloomington, IN 47404-3846 | 2016-08-18 |
| 1699127886 | Desirae Deniece Draluck | Counselor | 645 N Walnut St, Bloomington, IN 47404-3846 | 2016-07-12 |
| 1154776680 | Andrea Cheek | Social Worker | 645 N Walnut St, Bloomington, IN 47404-3846 | 2016-05-03 |
| 1235505876 | Kaitlin King | Social Worker | 645 N Walnut St, Bloomington, IN 47404-3846 | 2015-08-18 |
| 1447626080 | Shelby Robertson | Social Worker | 645 N Walnut St, Bloomington, IN 47404-3846 | 2015-08-18 |
| 1578939641 | Maria Roncalli | Counselor | 645 N Walnut St, Bloomington, IN 47404-3846 | 2015-08-12 |
| 1053744474 | Amethyst House | Social Worker | 645 N Walnut St, Bloomington, IN 47404-3846 | 2013-08-21 |
| 1891052908 | Walt Keller | Psychologist | 645 N Walnut St, Bloomington, IN 47404-3846 | 2012-04-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013526631 | Sandra Clark | Counselor | 205 N College Avenue, Suite 210a, Bloomington, IN 47404 | 2020-07-29 |
| 1750926085 | Michelle Christine Dustin | Nurse Practitioner | 610 N Morton Street, Bloomigton, IN 47404 | 2019-11-11 |
| 1316440191 | Julie D'argent | Psychologist | 205 N College Ave Ste 430, Bloomington, IN 47404 | 2018-03-17 |
| 1770966467 | Richard Lawson | Counselor | 1117 North Jackson Street, Bloomington, IN 47404 | 2015-06-30 |
| 1477952109 | Teresa R. Foster | Social Worker | 205 N. College Avenue, Suite 210b, Bloomington, IN 47404 | 2014-08-19 |
| 1073879532 | First Health Plus, Inc | Clinic/Center | 104 North Curry Pike, Bloomington, IN 47404 | 2012-04-09 |
| 1497079982 | Tera Dee Nance | Counselor | 101 W. Kirkwood Avenue, Suite 009 Fountain Square Mall, Bloomington, IN 47404 | 2010-03-26 |
| 1962643114 | Pathways Counseling Center | Community/Behavioral Health | 3866 W. Third Street, Bloomington, IN 47404 | 2009-03-18 |
| 1932358595 | Catherine Elizabeth Batka | Psychologist | 101 W. Kirkwood Ave, Suite 103, Bloomington, IN 47404 | 2008-09-18 |
| 1396901005 | Kijin Woo | Dentist | 330 N Jacob Drive, Bloomington, IN 47404 | 2008-08-01 |
| Find all providers in zip 47404 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
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| 1710364450 | Social Science Services, Inc. | Substance Abuse Rehabilitation Facility | 10888 Maple Ave, Bloomington, CA 92316-2621 | 2015-05-01 |
| 1245781079 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2016-10-17 |
| 1609021997 | Chestnut Health Systems | Substance Abuse Rehabilitation Facility | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2008-12-01 |
| 1861648412 | Social Science Services, Inc. | Substance Abuse Rehabilitation Facility | 18612 Santa Ana Ave, Bloomington, CA 92316-2636 | 2008-08-14 |
| 1710103304 | Dorothy R Garnette | Substance Abuse Rehabilitation Facility | 18612 Santa Ana Ave, Bloomington, CA 92316-2636 | 2007-04-18 |
| 1548303480 | Social Science Services Inc. | Substance Abuse Rehabilitation Facility | 18612 Santa Ana Ave, Bloomington, CA 92316-2636 | 2007-02-14 |
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| 1881157329 | Grace Recovery and Wellness LLC | Substance Abuse Rehabilitation Facility | 3320 Main St Ste D, Anderson, IN 46013-4267 | 2019-04-11 |
| 1679035232 | Summit Bhc Henryvillle | Substance Abuse Rehabilitation Facility | 2602 Hebron Church Rd, Henryville, IN 47126-9021 | 2019-04-03 |
| 1457819195 | The Breakaway Corp | Substance Abuse Rehabilitation Facility | 1514 E Spring St, New Albany, IN 47150-2844 | 2019-03-12 |
| Find all providers with the same taxonomy | ||||
| City | BLOOMINGTON |
| Zip Code | 47404 |
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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.