Healthcare Provider Details

I. General information

NPI: 1124931902
Provider Name (Legal Business Name): AMETHYST HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 STONEHAVEN DR
ALBEMARLE NC
28001-9149
US

IV. Provider business mailing address

125 7TH AVE
ALBEMARLE NC
28001-4442
US

V. Phone/Fax

Practice location:
  • Phone: 704-991-5998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ASSATA CARPENTER
Title or Position: CO-OWNER
Credential:
Phone: 704-991-5998