Provider Demographics
NPI:1730116062
Name:ATLANTIC HEALTHCARE GROUP INC
Entity Type:Organization
Organization Name:ATLANTIC HEALTHCARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-488-4001
Mailing Address - Street 1:911 CREEL ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-5001
Mailing Address - Country:US
Mailing Address - Phone:843-488-4001
Mailing Address - Fax:843-488-4005
Practice Address - Street 1:911 CREEL ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-5001
Practice Address - Country:US
Practice Address - Phone:843-488-4001
Practice Address - Fax:843-488-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0189Medicaid