Provider Demographics
NPI:1588844674
Name:AMETHYST HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:AMETHYST HOME HEALTH CARE AGENCY, LLC
Other - Org Name:AMETHYST HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ATILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-547-9368
Mailing Address - Street 1:2800 W PARKER RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-9164
Mailing Address - Country:US
Mailing Address - Phone:972-612-8889
Mailing Address - Fax:972-612-8288
Practice Address - Street 1:2800 W PARKER RD STE 111
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-9164
Practice Address - Country:US
Practice Address - Phone:972-612-8889
Practice Address - Fax:972-612-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011888OtherDEPARTMENT OF AGING AND DISABILITY SERVICES
TX74-7162Medicare PIN