Provider Demographics
NPI:1851908388
Name:ATLANTIC CARE SERVICES HAINES CITY LLC
Entity Type:Organization
Organization Name:ATLANTIC CARE SERVICES HAINES CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-484-2972
Mailing Address - Street 1:1845 OAK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1533
Mailing Address - Country:US
Mailing Address - Phone:407-484-2972
Mailing Address - Fax:407-559-8971
Practice Address - Street 1:651 E MAIN ST STE 12
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4241
Practice Address - Country:US
Practice Address - Phone:407-270-5501
Practice Address - Fax:407-559-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108212400Medicaid