Provider Demographics
NPI:1790288009
Name:ALTA CENTERS, INC.
Entity Type:Organization
Organization Name:ALTA CENTERS, INC.
Other - Org Name:ALTA CENTERS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN KOVN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-616-7443
Mailing Address - Street 1:6100 RODGERTON DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1964
Mailing Address - Country:US
Mailing Address - Phone:818-616-7443
Mailing Address - Fax:818-301-2046
Practice Address - Street 1:6100 RODGERTON DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1964
Practice Address - Country:US
Practice Address - Phone:818-616-7443
Practice Address - Fax:818-301-2046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTA CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-13
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190852CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility