Provider Demographics
NPI:1740954585
Name:ATLANTIC TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:ATLANTIC TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHODIPE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-615-4312
Mailing Address - Street 1:380 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3502
Mailing Address - Country:US
Mailing Address - Phone:410-615-4312
Mailing Address - Fax:
Practice Address - Street 1:380 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3502
Practice Address - Country:US
Practice Address - Phone:410-615-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)