Provider Demographics
NPI:1407061930
Name:ALTAMED HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:ALTAMED HEALTH SERVICES CORP
Other - Org Name:ALTAMED GOLDEN AGE ADHC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:U
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-622-2429
Mailing Address - Street 1:2040 CAMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1501
Mailing Address - Country:US
Mailing Address - Phone:323-725-8751
Mailing Address - Fax:323-889-7850
Practice Address - Street 1:3820 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-632-0415
Practice Address - Fax:310-639-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000588261QA0600X, 261QF0400X
CAAUDF0030G261QA0600X
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADUF0030GMedicaid