Provider Demographics
NPI:1598316606
Name:ATLANTIC CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:ATLANTIC CARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KASSA
Authorized Official - Middle Name:TESSEMA
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-980-9770
Mailing Address - Street 1:11712 MOORPARK ST STE 202
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2163
Mailing Address - Country:US
Mailing Address - Phone:818-980-9770
Mailing Address - Fax:818-980-9771
Practice Address - Street 1:11712 MOORPARK ST STE 202
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2163
Practice Address - Country:US
Practice Address - Phone:323-788-0046
Practice Address - Fax:818-980-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551617Medicaid