Provider Demographics
NPI:1598207417
Name:ATLANTICARE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ATLANTICARE HEALTH SERVICES, INC.
Other - Org Name:ATLANTICARE LIFE CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CASIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-407-2052
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7022
Practice Address - Country:US
Practice Address - Phone:609-407-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTICARE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH7619Medicare UPIN