Provider Demographics
NPI:1598039844
Name:ATLANTIC CARE SERVICES
Entity Type:Organization
Organization Name:ATLANTIC CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-690-9585
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-1031
Mailing Address - Country:US
Mailing Address - Phone:386-690-9585
Mailing Address - Fax:
Practice Address - Street 1:800 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3304
Practice Address - Country:US
Practice Address - Phone:386-690-9585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9595251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health