Provider Demographics
NPI:1295406247
Name:ALTUM HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ALTUM HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUFINO
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:630-755-1653
Mailing Address - Street 1:908 S FLORIDA AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1177
Mailing Address - Country:US
Mailing Address - Phone:630-755-1653
Mailing Address - Fax:
Practice Address - Street 1:6155 S FLORIDA AVE STE 15A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3323
Practice Address - Country:US
Practice Address - Phone:630-755-1653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty