Provider Demographics
NPI:1427002070
Name:ATLANTIC SHORES HOSPITAL L.L.C.
Entity Type:Organization
Organization Name:ATLANTIC SHORES HOSPITAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:4545 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068
Mailing Address - Country:US
Mailing Address - Phone:954-771-2711
Mailing Address - Fax:954-493-9998
Practice Address - Street 1:4545 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068
Practice Address - Country:US
Practice Address - Phone:954-771-2711
Practice Address - Fax:954-493-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4045283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010358600Medicaid
FL015005400Medicaid
FL104065Medicare UPIN