1205030848 NPI number — ALTAMED HEALTH SERVICES CORP.

Table of content: (NPI 1205030848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205030848 NPI number — ALTAMED HEALTH SERVICES CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTAMED HEALTH SERVICES CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALTAMED RUGBY PLAZA ADHC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205030848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CITADEL DR STE 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90040-1589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-889-7349
Provider Business Mailing Address Fax Number:
323-889-7843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6330 RUGBY AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-227-7678
Provider Business Practice Location Address Fax Number:
323-277-7686
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELDMAN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR, CLIENT SERVICES
Authorized Official Telephone Number:
323-889-7349

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  ADUF0117F , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ADUF0117F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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