Healthcare Provider Details

I. General information

NPI: 1932883741
Provider Name (Legal Business Name): AMETHYST RECOVERY SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PORTLAND AVE
SAINT PAUL MN
55102-2218
US

IV. Provider business mailing address

5862 BURKE TRL
INVER GROVE HEIGHTS MN
55076-1583
US

V. Phone/Fax

Practice location:
  • Phone: 651-494-4446
  • Fax:
Mailing address:
  • Phone: 612-269-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA HAREIN
Title or Position: TREASURER
Credential:
Phone: 612-269-6544