Provider Demographics
NPI:1174639702
Name:VITAS HEALTHCARE CORPORATION ATLANTIC
Entity Type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION ATLANTIC
Other - Org Name:VITAS INNOVATIVE HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-350-6925
Mailing Address - Street 1:7400 BEAUFONT SPRINGS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5556
Mailing Address - Country:US
Mailing Address - Phone:804-672-4462
Mailing Address - Fax:804-672-4435
Practice Address - Street 1:7400 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5556
Practice Address - Country:US
Practice Address - Phone:804-672-4462
Practice Address - Fax:804-672-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAAPPLIES FOR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491587Medicare Oscar/Certification