Provider Demographics
NPI:1396215158
Name:ATL COMMUNITY LIVING LLC
Entity Type:Organization
Organization Name:ATL COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRYAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-205-4732
Mailing Address - Street 1:6024 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3733
Mailing Address - Country:US
Mailing Address - Phone:267-205-4732
Mailing Address - Fax:
Practice Address - Street 1:5231 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4020
Practice Address - Country:US
Practice Address - Phone:267-205-4732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility