Provider Demographics
NPI:1659781607
Name:ALTA CARE HOMEHEALTH, INC,
Entity Type:Organization
Organization Name:ALTA CARE HOMEHEALTH, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILMER
Authorized Official - Middle Name:AQUINO
Authorized Official - Last Name:COMAHIG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-478-9934
Mailing Address - Street 1:6280 S VALLEY VIEW BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3814
Mailing Address - Country:US
Mailing Address - Phone:702-478-9934
Mailing Address - Fax:702-478-9461
Practice Address - Street 1:6280 S VALLEY VIEW BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3814
Practice Address - Country:US
Practice Address - Phone:702-478-9934
Practice Address - Fax:702-478-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141141146681251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297210Medicare Oscar/Certification