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General NPI Number Information
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NPI Number | 1265943781
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Entity Type | Organization
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Legal Business Name | ALTA HEALTCARE SERVICES
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 101 LAKEFOREST BLVD STE 250
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2633
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Country | US
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Telephone | 240-506-1728
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Fax |
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Provider Business Mailing Address
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Address Line | 21506 MANOR VIEW CIR
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City | GERMANTOWN
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State | MD
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Zip | 20876-5924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HANNAH DIBONGE
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Credential | PHARMD
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Telephone | 240-506-1728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH-2371
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License Number State | MD
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