1699760157 NPI number — ATLANTICARE HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699760157 NPI number — ATLANTICARE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTICARE HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699760157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 DELILAH RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
EGG HARBOR TWP
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08234-5142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-407-2020
Provider Business Mailing Address Fax Number:
609-407-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 DELILAH RD.
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
EGG HARBOR TWP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234-5142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-407-2020
Provider Business Practice Location Address Fax Number:
609-407-2021
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MEREDITH
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-407-2020

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  22853 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5060508 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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