Provider Demographics
NPI:1417560343
Name:ATLANTIS HOMECARE SUPPORT SERVICES
Entity Type:Organization
Organization Name:ATLANTIS HOMECARE SUPPORT SERVICES
Other - Org Name:ATLANTIS RESIDENTIAL SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:412-736-3504
Mailing Address - Street 1:141 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-3502
Mailing Address - Country:US
Mailing Address - Phone:412-736-3504
Mailing Address - Fax:
Practice Address - Street 1:141 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3502
Practice Address - Country:US
Practice Address - Phone:412-736-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health