Provider Demographics
NPI:1174195853
Name:ALTA ACUTE DIALYSIS, LLC
Entity Type:Organization
Organization Name:ALTA ACUTE DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-858-9138
Mailing Address - Street 1:8313 SOUTHWEST FWY STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1652
Mailing Address - Country:US
Mailing Address - Phone:713-489-9989
Mailing Address - Fax:713-484-8132
Practice Address - Street 1:8313 SOUTHWEST FWY STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1652
Practice Address - Country:US
Practice Address - Phone:713-489-9989
Practice Address - Fax:713-484-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care