Organization
ALTA DRIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE PEREZ (EXECUTIVE DIRECTOR)
(310) 876-4681
Entity
Organization
Contact information
Practice address
4015 PEORIA AVE, SIMI VALLEY, CA 93063-1657
(805) 584-2592
Mailing address
4015 PEORIA AVE, SIMI VALLEY, CA 93063-1657
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831741800
PPO
CA
Enumeration date
02/09/2021
Last updated
02/09/2021
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