Provider Demographics
NPI:1912888785
Name:ALTA HEATH PRACTICE LLC
Entity type:Organization
Organization Name:ALTA HEATH PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-277-1621
Mailing Address - Street 1:1193 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604
Mailing Address - Country:US
Mailing Address - Phone:203-428-1290
Mailing Address - Fax:
Practice Address - Street 1:1193 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604
Practice Address - Country:US
Practice Address - Phone:203-428-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care