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General NPI Number Information
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NPI Number | 1124931902
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Entity Type | Organization
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Legal Business Name | AMETHYST HOUSE LLC
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 2410 STONEHAVEN DR
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City | ALBEMARLE
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State | NC
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Zip | 28001-9149
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Country | US
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Telephone | 704-991-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 125 7TH AVE
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City | ALBEMARLE
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State | NC
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Zip | 28001-4442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ASSATA CARPENTER
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Credential |
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Telephone | 704-991-5998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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