Basic Information
| Provider Information | |||||||||
| NPI: | 1518127992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTA MIRA TREATMENT CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 WESTWOOD PL | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
| FaxNumber: | 9547279864 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 BULKLEY AVE | ||||||||
| Address2: | |||||||||
| City: | SAUSALITO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949652231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545877771 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 06/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | YVONNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING/COLLECTIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9545877771 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.