Alta Drive LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

ALTA DRIVE LLC

Practice address

4015 Peoria Ave
Simi Valley, CA 93063-1657

Phone

(805) 584-2592

NPI assigned

Feb 9, 2021

Last updated

Feb 9, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Perez

Title

Executive Director

Phone

(310) 876-4681

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1043802143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 PEORIA AVE",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930631657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 PEORIA AVE",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930631657",
            "telephone_number": "805-584-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA DRIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "310-876-4681"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPO",
            "identifier": "1831741800",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Admin@simihouse.org",
            "affiliation": "N",
            "address_1": "4015 Peoria Ave",
            "city": "Simi Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "930631657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.