Provider Demographics
NPI:1215662499
Name:AMETHYST RECOVERY HOMES
Entity type:Organization
Organization Name:AMETHYST RECOVERY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MORRISSEY
Authorized Official - Last Name:BAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-494-4446
Mailing Address - Street 1:5862 BURKE TRL
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:759 WINSLOW AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-3349
Practice Address - Country:US
Practice Address - Phone:651-494-4446
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?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodging
No174200000XOther Service ProvidersMeals
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty