Provider Demographics
NPI:1821131756
Name:VITAS HEALTHCARE CORPORATION ATLANTIC
Entity Type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION ATLANTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-374-4143
Mailing Address - Street 1:3046 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6547
Mailing Address - Country:US
Mailing Address - Phone:305-374-4143
Mailing Address - Fax:
Practice Address - Street 1:199 PARK ROAD EXT
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-437-3111
Practice Address - Fax:203-437-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0015251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008007941Medicaid
CT071533Medicare Oscar/Certification