MEDICARE: AMETHYST RECOVERY HOMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	175T00000X	Peer Specialist
3	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1215662499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMETHYST RECOVERY HOMES

Provider Business Mailing Address
First Line	:	5862 BURKE TRL
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1583
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	759 WINSLOW AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-3349
Country	:	US
Telephone Number	:	651-494-4446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MORRISSEY BAHR
Credential	:
Telephone Number	:	651-494-4446

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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