Provider Demographics
NPI:1043235229
Name:ATLANTIC HEALTH CAR
Entity Type:Organization
Organization Name:ATLANTIC HEALTH CAR
Other - Org Name:ATLANTIC HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-562-8800
Mailing Address - Street 1:6033 ATLANTIC BL
Mailing Address - Street 2:#8
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3193
Mailing Address - Country:US
Mailing Address - Phone:323-562-8800
Mailing Address - Fax:323-562-8811
Practice Address - Street 1:6033 ATLANTIC BL
Practice Address - Street 2:#8
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3193
Practice Address - Country:US
Practice Address - Phone:323-562-8800
Practice Address - Fax:323-562-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002002846-0001-0332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5387670001Medicare NSC