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NPI Code Detail

MEDICARE: ALTA CARE GROUP, INC.

MEDICARE: ALTA CARE GROUP, INC.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)0222OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215905385
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTA CARE GROUP, INC.
Provider Business Mailing Address
First Line : 711 BELMONT AVE.
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44502-1039
Country : US
Telephone Number : 330-793-2487
Fax Number : 330-743-5748
Provider Business Practice Location Address
First Line : 711 BELMONT AVE.
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44502-1039
Country : US
Telephone Number : 330-793-2487
Fax Number : 330-743-5748
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JOSPEH J SHOROKEY
Credential : LPCC-S
Telephone Number : 330-793-2487
Provider Enumeration Date : 03/14/2006
Last Update Date : 04/20/2016

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Directions to “ALTA CARE GROUP, INC. ” Practice Location

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