Healthcare Provider Details

I. General information

NPI: 1396949939
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-3625
US

IV. Provider business mailing address

500 CITADEL DR STE 490
LOS ANGELES CA
90040-1589
US

V. Phone/Fax

Practice location:
  • Phone: 310-632-0415
  • Fax: 310-605-5438
Mailing address:
  • Phone: 323-889-7349
  • Fax: 323-889-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADUF0030G
License Number StateCA

VIII. Authorized Official

Name: MR. PETER M FELDMAN
Title or Position: DIRECTOR, CLIENT SERVICES
Credential: MFT
Phone: 323-889-7349