Healthcare Provider Details

I. General information

NPI: 1134777360
Provider Name (Legal Business Name): ALTA CARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BELMONT AVE
YOUNGSTOWN OH
44502-1039
US

IV. Provider business mailing address

711 BELMONT AVE
YOUNGSTOWN OH
44502-1039
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-2487
  • Fax: 330-743-5748
Mailing address:
  • Phone: 330-793-2487
  • Fax: 330-743-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN C BAUGHMAN
Title or Position: HUMAN RESOURCE OFFICER
Credential: SHRM-CP
Phone: 330-793-2487