Provider Demographics
NPI:1558981340
Name:ATLASVILLE, LLC
Entity Type:Organization
Organization Name:ATLASVILLE, LLC
Other - Org Name:ATLASVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NKECHINYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-377-8511
Mailing Address - Street 1:4025 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4226
Mailing Address - Country:US
Mailing Address - Phone:301-377-8511
Mailing Address - Fax:301-220-1751
Practice Address - Street 1:1350 SHADES LN
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1338
Practice Address - Country:US
Practice Address - Phone:301-377-8511
Practice Address - Fax:301-220-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR4448OtherRSA
MD904902900Medicaid