Provider Demographics
NPI:1205994969
Name:ALTIMA HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:ALTIMA HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-897-0404
Mailing Address - Street 1:11115 MILLS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3036
Mailing Address - Country:US
Mailing Address - Phone:281-897-0404
Mailing Address - Fax:832-862-5782
Practice Address - Street 1:11115 MILLS RD STE 108
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3036
Practice Address - Country:US
Practice Address - Phone:281-897-0404
Practice Address - Fax:832-862-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008825251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008825OtherTX LICENSE NUMBER
SW22276Medicare ID - Type Unspecified
TX453110Medicare ID - Type Unspecified