Provider Demographics
NPI:1952036303
Name:AMETHYST HOUSE , INC.
Entity Type:Organization
Organization Name:AMETHYST HOUSE , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:FEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:347-630-1416
Mailing Address - Street 1:280 RICHMOND TER
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1512
Mailing Address - Country:US
Mailing Address - Phone:718-448-1900
Mailing Address - Fax:
Practice Address - Street 1:280 RICHMOND TER
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1512
Practice Address - Country:US
Practice Address - Phone:718-448-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000030373OtherNYS VENDOR ID
NY018638626OtherDUNS