Provider Demographics
NPI:1215231147
Name:ATLANTIC HOME CARE, INC.
Entity Type:Organization
Organization Name:ATLANTIC HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-667-0376
Mailing Address - Street 1:101 E 8TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1783
Mailing Address - Country:US
Mailing Address - Phone:610-667-0376
Mailing Address - Fax:610-667-0378
Practice Address - Street 1:101 E 8TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1783
Practice Address - Country:US
Practice Address - Phone:610-667-0376
Practice Address - Fax:610-667-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04280501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102653869-0002Medicaid
PA25103601OtherPENNSYLVANIA DEPARTMENT OF HEALTH