Provider Demographics
NPI:1720659329
Name:ALTITUDE ADJUSTMENT
Entity Type:Organization
Organization Name:ALTITUDE ADJUSTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-851-7798
Mailing Address - Street 1:4602 SOUTHERN PKWY STE 1B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1442
Mailing Address - Country:US
Mailing Address - Phone:502-409-9553
Mailing Address - Fax:502-632-1590
Practice Address - Street 1:4602 SOUTHERN PKWY STE 1B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1442
Practice Address - Country:US
Practice Address - Phone:502-409-9553
Practice Address - Fax:502-632-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health