Provider Demographics
NPI:1518127992
Name:ALTA MIRA TREATMENT CENTERS
Entity Type:Organization
Organization Name:ALTA MIRA TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-587-7771
Mailing Address - Street 1:210 WESTWOOD PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7554
Mailing Address - Country:US
Mailing Address - Phone:954-587-7771
Mailing Address - Fax:954-727-9864
Practice Address - Street 1:125 BULKLEY AVE
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2231
Practice Address - Country:US
Practice Address - Phone:954-587-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility