Provider Demographics
NPI:1538307905
Name:ATLANTIC HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ATLANTIC HOME HEALTH CARE, INC.
Other - Org Name:ATLANTIC IN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-462-6707
Mailing Address - Street 1:808 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-8556
Mailing Address - Country:US
Mailing Address - Phone:772-462-6707
Mailing Address - Fax:772-462-6706
Practice Address - Street 1:808 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-8556
Practice Address - Country:US
Practice Address - Phone:772-462-6707
Practice Address - Fax:772-462-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211036251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685799000Medicaid