Provider Demographics
NPI:1023571320
Name:ATLANTIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:ATLANTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:IKHELOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-704-4317
Mailing Address - Street 1:1111 W MAIN ST APT 504
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1593
Mailing Address - Country:US
Mailing Address - Phone:872-704-4317
Mailing Address - Fax:
Practice Address - Street 1:1111 W MAIN ST APT 504
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1593
Practice Address - Country:US
Practice Address - Phone:872-704-4317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty