Provider Demographics
NPI:1639538929
Name:ALTUS TREATMENT SERVICES
Entity Type:Organization
Organization Name:ALTUS TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:NILES
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:949-521-6138
Mailing Address - Street 1:145 COLUMBIA
Mailing Address - Street 2:STE 200
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1413
Mailing Address - Country:US
Mailing Address - Phone:949-521-6138
Mailing Address - Fax:949-521-7926
Practice Address - Street 1:145 COLUMBIA
Practice Address - Street 2:STE 200
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1413
Practice Address - Country:US
Practice Address - Phone:949-521-6138
Practice Address - Fax:949-521-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility