Healthcare Provider Details

I. General information

NPI: 1447812755
Provider Name (Legal Business Name): ALTERA VITA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7632 E FAIR MEADOWS LOOP
TUCSON AZ
85756-6151
US

IV. Provider business mailing address

7632 E FAIR MEADOWS LOOP
TUCSON AZ
85756-6151
US

V. Phone/Fax

Practice location:
  • Phone: 520-400-1708
  • Fax:
Mailing address:
  • Phone: 520-400-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KARLI KING
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 520-400-1708