Provider Demographics
NPI:1902273170
Name:ALTRA SERVICES INC
Entity Type:Organization
Organization Name:ALTRA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-214-1343
Mailing Address - Street 1:2114 GLENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3445
Mailing Address - Country:US
Mailing Address - Phone:970-214-1343
Mailing Address - Fax:970-667-8016
Practice Address - Street 1:2114 GLENWOOD CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3445
Practice Address - Country:US
Practice Address - Phone:970-214-1343
Practice Address - Fax:970-667-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27981274320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27981274Medicaid