Provider Demographics
NPI:1346671302
Name:ATLANTIC HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:ATLANTIC HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANJELIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALATYANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-797-0739
Mailing Address - Street 1:5600 WEST BROWN DEER ROAD
Mailing Address - Street 2:#216
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-797-0739
Mailing Address - Fax:414-797-0743
Practice Address - Street 1:5600 WEST BROWN DEER ROAD
Practice Address - Street 2:#216
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-797-0739
Practice Address - Fax:414-797-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
WI1184251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health