Provider Demographics
NPI:1881353019
Name:ALTICARE HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:ALTICARE HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATENG-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BA,FNP-BC,DNP
Authorized Official - Phone:917-488-7910
Mailing Address - Street 1:3403 ROPES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3403 ROPES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1016
Practice Address - Country:US
Practice Address - Phone:917-488-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty