- Enrollment id
- O20141208001042
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1659781607
- Multiple npi flag
- N
- Ccn
- 297210
- Associate id
- 3678895323
- Organization name
- ALTA CARE HOMEHEALTH INC
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2675 S JONES BLVD
- Address line 2
- STE 112
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891465607