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General NPI Number Information
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NPI Number | 1003123175
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Entity Type | Organization
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Legal Business Name | ALTA HEALTHCARE GROUP, INC
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 5520 HOWELL BRANCH RD
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City | WINTER PARK
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State | FL
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Zip | 32792-9327
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Country | US
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Telephone | 407-435-2402
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Fax | 407-695-7720
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Provider Business Mailing Address
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Address Line | 4279 FOX HOLLOW CIR
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City | CASSELBERRY
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State | FL
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Zip | 32707-5240
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Country | US
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Telephone | 407-435-2402
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Fax | 407-695-7720
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ALBERT GREEN
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Credential |
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Telephone | 407-435-2402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL8419
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License Number State | FL
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