Provider Demographics
NPI:1811260367
Name:ATENA DYNAMIC HEALTH CARE
Entity type:Organization
Organization Name:ATENA DYNAMIC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ATEMNKENG
Authorized Official - Last Name:NTENTINUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-772-7889
Mailing Address - Street 1:6917 CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105
Mailing Address - Country:US
Mailing Address - Phone:216-772-7889
Mailing Address - Fax:216-641-8833
Practice Address - Street 1:6917 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105
Practice Address - Country:US
Practice Address - Phone:216-772-7889
Practice Address - Fax:216-641-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health