Provider Demographics
NPI:1821520909
Name:ATLAS HOME CARE CARE SERVICES
Entity Type:Organization
Organization Name:ATLAS HOME CARE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:THABO
Authorized Official - Last Name:LANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-921-9200
Mailing Address - Street 1:6509 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2816
Mailing Address - Country:US
Mailing Address - Phone:215-921-9200
Mailing Address - Fax:215-921-9727
Practice Address - Street 1:6509 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2816
Practice Address - Country:US
Practice Address - Phone:215-921-9200
Practice Address - Fax:215-921-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6300052164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033589981Medicaid
PA1821529801Medicaid