Provider Demographics
NPI:1912491739
Name:ATLANTIC HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:ATLANTIC HEALTHCARE SERVICES LLC
Other - Org Name:ATLANTIC HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-898-8450
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8450
Mailing Address - Fax:216-898-8455
Practice Address - Street 1:5372 FALLOWATER LN STE 200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0909
Practice Address - Country:US
Practice Address - Phone:216-898-8399
Practice Address - Fax:216-898-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty