Provider Demographics
NPI:1720117807
Name:ATLANTIC DEVELOPMENTAL SERVICE INC
Entity Type:Organization
Organization Name:ATLANTIC DEVELOPMENTAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-214-4914
Mailing Address - Street 1:1515 SE LUCKHARDT ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5758
Mailing Address - Country:US
Mailing Address - Phone:772-214-4914
Mailing Address - Fax:772-781-0332
Practice Address - Street 1:1515 SE LUCKHARDT ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5758
Practice Address - Country:US
Practice Address - Phone:772-214-4914
Practice Address - Fax:772-781-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies