Provider Demographics
NPI:1851110050
Name:ALTITUDE ACADEMY
Entity type:Organization
Organization Name:ALTITUDE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRISTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:404-901-8788
Mailing Address - Street 1:13 EDDIE HOLMES COURT
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920
Mailing Address - Country:US
Mailing Address - Phone:404-901-8788
Mailing Address - Fax:
Practice Address - Street 1:13 EDDIE HOLMES COURT
Practice Address - Street 2:
Practice Address - City:SAINT HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920
Practice Address - Country:US
Practice Address - Phone:404-901-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health