1306285820 NPI number — ALT RECOVERY GROUP LLC

Table of content: (NPI 1306285820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306285820 NPI number — ALT RECOVERY GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALT RECOVERY GROUP 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:
1306285820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 MALL DR
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-8194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-522-0660
Provider Business Mailing Address Fax Number:
575-522-3151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 MALL DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-8194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-522-0660
Provider Business Practice Location Address Fax Number:
575-522-3151
Provider Enumeration Date:
06/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LANZA
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-503-3898

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: NM10059M , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42738229 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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