NPIMap

Organization Active NPI

Alta Healthcare Services, Inc.

  • Rehabilitation Clinic/Center
  • Gaithersburg, MD
National Provider Identifier
1821789389
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
ALTA HEALTHCARE SERVICES, INC.
Practice address
101 Lakeforest Blvd Ste 250
Gaithersburg, MD 20877-2633
Phone
(240) 801-9818
Fax
(240) 801-9819
NPI assigned
May 16, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Authorized official

Name
Hannah Dibonge
Title
Administrator
Phone
(301) 540-8230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

101 Lakeforest Blvd Ste 250
Gaithersburg, MD 20877-2633

Mailing address

101 Lakeforest Blvd Ste 250
Gaithersburg, MD 20877-2633
Phone (240) 801-9818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200319000078 DC Part B Supplier - Clinic/Group Practice 1355779778 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Gaithersburg, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1821789389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LAKEFOREST BLVD STE 250",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772633",
            "telephone_number": "240-801-9818",
            "fax_number": "240-801-9819"
        },
        {
            "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",
            "fax_number": "240-801-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "DIBONGE",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-540-8230"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.