Provider Demographics
NPI:1891534772
Name:ALTA CARE ADHC LLC
Entity type:Organization
Organization Name:ALTA CARE ADHC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:KEIVANFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-717-3993
Mailing Address - Street 1:4219 BONAVITA DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3524
Mailing Address - Country:US
Mailing Address - Phone:310-717-3993
Mailing Address - Fax:
Practice Address - Street 1:418 W 4TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5912
Practice Address - Country:US
Practice Address - Phone:310-717-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care