NPIMap

Organization Active NPI

Alta Healthcare Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gaithersburg, MD
National Provider Identifier
1114674058
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
ALTA HEALTHCARE SERVICES LLC
Practice address
101 Lakeforest Blvd Ste 250
Gaithersburg, MD 20877-2633
Phone
(240) 801-9818
NPI assigned
Mar 9, 2022
Last updated
Mar 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Hannah Dibonge
Title
Ceo
Phone
(240) 506-1728

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

101 Lakeforest Blvd Ste 250
Gaithersburg, MD 20877-2633

Mailing address

21506 Manor View Cir
Germantown, MD 20876-5924
Phone (240) 506-1728

National Provider Directory

National Provider Directory
Tax ID family
Alta Healthcare Services LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1114674058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21506 MANOR VIEW CIR",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208765924",
            "telephone_number": "240-506-1728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LAKEFOREST BLVD STE 250",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772633",
            "telephone_number": "240-801-9818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "DIBONGE",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-506-1728"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.