MEDICARE: ATLANTICARE MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134459712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTICARE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	46 MOUNT EBO RD N
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-3600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 MOUNT EBO RD N
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-3600
Country	:	US
Telephone Number	:	845-278-3636
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ERIC GREENBERGER
Credential	:
Telephone Number	:	845-278-3636

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	05/27/2010

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