Provider Demographics
NPI:1366820581
Name:ALTA HEALTH SERVICES
Entity type:Organization
Organization Name:ALTA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-563-8500
Mailing Address - Street 1:1418 N-R BOSTON/PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:NORWOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-440-9911
Mailing Address - Fax:813-882-0040
Practice Address - Street 1:1418 BOSTON PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-440-9911
Practice Address - Fax:813-882-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies