Provider Demographics
NPI:1073384517
Name:ATLANTIC HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:ATLANTIC HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-766-1284
Mailing Address - Street 1:PO BOX 8152
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-8152
Mailing Address - Country:US
Mailing Address - Phone:207-766-1284
Mailing Address - Fax:207-309-3009
Practice Address - Street 1:75 BISHOP ST STE 15A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2614
Practice Address - Country:US
Practice Address - Phone:074-201-7692
Practice Address - Fax:207-309-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care