Provider Demographics
NPI:1851864995
Name:ATLAS PROFESSIONAL HOME CARE
Entity Type:Organization
Organization Name:ATLAS PROFESSIONAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:NATO
Authorized Official - Last Name:ITOKA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:240-643-4919
Mailing Address - Street 1:16 LINDA CT APT A
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3084
Mailing Address - Country:US
Mailing Address - Phone:240-643-4919
Mailing Address - Fax:
Practice Address - Street 1:16 LINDA CT APT A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3084
Practice Address - Country:US
Practice Address - Phone:240-643-4919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424051100Medicaid