Provider Demographics
NPI:1922089119
Name:ATLAS CARE ENTERPRISES INCORPORATED
Entity Type:Organization
Organization Name:ATLAS CARE ENTERPRISES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:CONSOLACION
Authorized Official - Suffix:
Authorized Official - Credentials:NHA5683
Authorized Official - Phone:323-261-8108
Mailing Address - Street 1:101 S FICKETT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-4017
Mailing Address - Country:US
Mailing Address - Phone:323-261-8108
Mailing Address - Fax:323-261-8213
Practice Address - Street 1:101 S FICKETT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4017
Practice Address - Country:US
Practice Address - Phone:323-261-8108
Practice Address - Fax:323-261-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970000035314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06063HMedicaid
05-6063Medicare ID - Type UnspecifiedMUTUAL OF OMAHA