Provider Demographics
NPI:1336142538
Name:ATRIUM CARE AND REHABILITATION
Entity Type:Organization
Organization Name:ATRIUM CARE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:904-724-4001
Mailing Address - Street 1:9960 ATRIUM WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-724-4004
Mailing Address - Fax:904-724-6690
Practice Address - Street 1:9960 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6487
Practice Address - Country:US
Practice Address - Phone:904-724-4004
Practice Address - Fax:904-724-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1648096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105927Medicare ID - Type UnspecifiedMEDICARE NUMBER