Provider Demographics
NPI:1134459712
Name:ATLANTICARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:ATLANTICARE MANAGEMENT LLC
Other - Org Name:PUTNAM RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-278-3636
Mailing Address - Street 1:46 MOUNT EBO RD N
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-3600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 MOUNT EBO RD N
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-3600
Practice Address - Country:US
Practice Address - Phone:845-278-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997708Medicaid
NY02997708Medicaid