Provider Demographics
NPI:1366470981
Name:ALTIMA HEALTHCARE INC
Entity Type:Organization
Organization Name:ALTIMA HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:818-838-0667
Mailing Address - Street 1:10600 SEPULVEDA BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1971
Mailing Address - Country:US
Mailing Address - Phone:818-838-0667
Mailing Address - Fax:
Practice Address - Street 1:10600 SEPULVEDA BLVD STE 111
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1971
Practice Address - Country:US
Practice Address - Phone:818-838-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18900Medicare ID - Type Unspecified