1023389848 NPI number — ALTRUS LLC

Table of content: (NPI 1023389848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023389848 NPI number — ALTRUS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTRUS LLC
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:
Provider Other Organization Name Type Code:
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:
1023389848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 S STATE ST FL 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60603-2804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-762-9999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 DAVIS RD STE 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30907-0207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-354-6011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHIZHEVSKY
Authorized Official First Name:
RUSTY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. GENERAL COUNSEL
Authorized Official Telephone Number:
847-840-1894

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PCH012199 . This is a "GEORGIA DEPT OF COMMUNITY HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000437269B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PCH010021 . This is a "STATE OF GA PERSONAL CARE HOME PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: PCH012221 . This is a "STATE OF GA PERSONAL CARE HOME PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: PCH009257 . This is a "GA DEPT OF COMMUNITY HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: PCH010021 . This is a "PERSONAL CARE HOME" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: PCH012245 . This is a "HFRD LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com