Healthcare Provider Details

I. General information

NPI: 1033249958
Provider Name (Legal Business Name): ALTA HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S HAMILTON RD UNIT 9
COLUMBUS OH
43213-3003
US

IV. Provider business mailing address

904 S HAMILTON RD
COLUMBUS OH
43213-3003
US

V. Phone/Fax

Practice location:
  • Phone: 614-891-2582
  • Fax:
Mailing address:
  • Phone: 614-891-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DERRICK PENA
Title or Position: MANAGING MEMBER
Credential:
Phone: 614-891-2582