Provider Demographics
NPI:1740472174
Name:ATLAS BEHAVIORAL HEALTH, PA
Entity type:Organization
Organization Name:ATLAS BEHAVIORAL HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCHELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS,ARNP
Authorized Official - Phone:386-446-5494
Mailing Address - Street 1:50 LEANNI WAY UNIT B3
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4754
Mailing Address - Country:US
Mailing Address - Phone:386-446-5494
Mailing Address - Fax:386-447-1357
Practice Address - Street 1:50 LEANNI WAY UNIT B3
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4754
Practice Address - Country:US
Practice Address - Phone:386-446-5494
Practice Address - Fax:386-447-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF969Medicare PIN