MEDICARE: AMETHYST HOUSE , INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000030373	OTHER	NY	NYS VENDOR ID
2	018638626	OTHER	NY	DUNS

General Provider Information

NPI Number	:	1952036303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMETHYST HOUSE , INC.

Provider Business Mailing Address
First Line	:	280 RICHMOND TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-1512
Country	:	US
Telephone Number	:	718-448-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 RICHMOND TER
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-1512
Country	:	US
Telephone Number	:	718-448-1900
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	CARL FEREN
Credential	:	MBA
Telephone Number	:	347-630-1416

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

Similar Medicare Providers

1063342335 — ADAM ASARALI
Practice Location Address:

420 SOUTH AVE
STATEN ISLAND, NY
10303-1512

Practice Phone: 347-881-3407
Practice Fax:

1114581113 — SHAKIA FREEMAN
Practice Location Address:

420 SOUTH AVE FL 2
STATEN ISLAND, NY
10303-1512

Practice Phone: 347-881-3407
Practice Fax: 718-816-0048

1265082259 — MISS GOLDEN CHEYENNE BROOKS BSW
Practice Location Address:

184 HARRISON PL
STATEN ISLAND, NY
10310-1512

Practice Phone: 347-232-2875
Practice Fax:

1649046996 — RAENA S MCCARTHY LMSW
Practice Location Address:

27 LORRAINE LOOP
STATEN ISLAND, NY
10309-1512

Practice Phone: 917-414-6330
Practice Fax:

1164396412 — RASHIA FIELDS
Practice Location Address:

420 SOUTH AVE STE 129
STATEN ISLAND, NY
10303-1512

Practice Phone: 862-704-5803
Practice Fax: 862-704-5803

1609711563 — MOHAMED MOHAMED AHMED MHC
Practice Location Address:

420 SOUTH AVE STE 4B
STATEN ISLAND, NY
10303-1512

Practice Phone: 347-881-3407
Practice Fax: 718-816-0048

Directions to “AMETHYST HOUSE , INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.