Provider Demographics
NPI:1477799294
Name:ATLANTICARE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ATLANTICARE HEALTH SERVICES, INC.
Other - Org Name:T.E.A.M. DIABETES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-272-6393
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:609-407-2354
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-407-2354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTICARE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-29
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057854Medicare PIN