Provider Demographics
NPI:1780224030
Name:AMERITA SOUTH ATLANTIC LLC
Entity Type:Organization
Organization Name:AMERITA SOUTH ATLANTIC LLC
Other - Org Name:ADVANCED HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILOLAHTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-282-2382
Mailing Address - Street 1:PO BOX 223017
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-2017
Mailing Address - Country:US
Mailing Address - Phone:800-477-7375
Mailing Address - Fax:877-676-0493
Practice Address - Street 1:3355 BRECKINRIDGE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4989
Practice Address - Country:US
Practice Address - Phone:770-500-3834
Practice Address - Fax:833-994-0847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174488OtherNCPDP