Amethyst Care Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

AMETHYST CARE HOME LLC

Practice address

3702 Internet Ave
North Las Vegas, NV 89031-4160

Phone

(702) 702-4854

NPI assigned

Jun 12, 2019

Last updated

Jun 12, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rolando Manago

Title

Managing Member

Phone

(702) 807-7634

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1346809373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 CACKLING GOOSE DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890842650",
            "telephone_number": "702-807-7634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 INTERNET AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890314160",
            "telephone_number": "702-702-4854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMETHYST CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-12",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "MANAGO",
        "authorized_official_first_name": "ROLANDO",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "702-807-7634"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPBH",
            "identifier": "8642-AGC-0",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "gilemiedecastro@cox.net",
            "affiliation": "N",
            "address_1": "3702 Internet Ave",
            "city": "North Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "890314160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.