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General NPI Number Information
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NPI Number | 1609910199
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Entity Type | Organization
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Legal Business Name | ALTAS PLACE INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 7820 FRUITRIDGE RD
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City | SACRAMENTO
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State | CA
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Zip | 95820-6743
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Country | US
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Telephone | 916-381-1594
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Fax | 916-381-2138
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Provider Business Mailing Address
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Address Line | 7820 FRUITRIDGE RD
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City | SACRAMENTO
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State | CA
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Zip | 95820-6743
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Country | US
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Telephone | 916-381-1594
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Fax | 916-381-2138
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | MISS VICKIE ELAINE BRATTON
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Credential |
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Telephone | 916-381-1594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | LTC60084F
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License Number State | CA
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