Provider Demographics
NPI:1518744838
Name:ALTACARE LLC
Entity type:Organization
Organization Name:ALTACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENOON
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-795-2838
Mailing Address - Street 1:301 BOARDWALK DR UNIT 270124
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-4004
Mailing Address - Country:US
Mailing Address - Phone:970-795-2838
Mailing Address - Fax:
Practice Address - Street 1:4348 WINTERSTONE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5656
Practice Address - Country:US
Practice Address - Phone:970-795-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty