Provider Demographics
NPI:1710560495
Name:ATLANTIS SAC OPCO LLC
Entity Type:Organization
Organization Name:ATLANTIS SAC OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-357-3560
Mailing Address - Street 1:312 ZACA RD
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-9400
Mailing Address - Country:US
Mailing Address - Phone:714-357-3560
Mailing Address - Fax:
Practice Address - Street 1:1922 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2136
Practice Address - Country:US
Practice Address - Phone:916-318-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility