MEDICARE: ALTA HOME HEALTH CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1033249958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	904 S HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3003
Country	:	US
Telephone Number	:	614-891-2582
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 S HAMILTON RD UNIT 9
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3003
Country	:	US
Telephone Number	:	614-891-2582
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DERRICK PENA
Credential	:
Telephone Number	:	614-891-2582

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	12/11/2025

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