Provider Demographics
NPI:1023389848
Name:ALTRUS LLC
Entity type:Organization
Organization Name:ALTRUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIZHEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-840-1894
Mailing Address - Street 1:33 S STATE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2804
Mailing Address - Country:US
Mailing Address - Phone:312-762-9999
Mailing Address - Fax:
Practice Address - Street 1:119 DAVIS RD STE 2B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0207
Practice Address - Country:US
Practice Address - Phone:912-354-6011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCH012199OtherGEORGIA DEPT OF COMMUNITY HEALTH
GA000437269BMedicaid
GAPCH010021OtherSTATE OF GA PERSONAL CARE HOME PERMIT
GAPCH012221OtherSTATE OF GA PERSONAL CARE HOME PERMIT
GAPCH009257OtherGA DEPT OF COMMUNITY HEALTH
GAPCH010021OtherPERSONAL CARE HOME
GAPCH012245OtherHFRD LICENSE