MEDICARE: ATLANTICARE HEALTH SERVICES, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1396485074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTICARE HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1401 ATLANTIC AVE STE 1125
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-7001
Country	:	US
Telephone Number	:	609-572-6051
Fax Number	:	609-572-6001

Provider Business Practice Location Address
First Line	:	1400 N ALBANY AVE STE G201A2
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-1208
Country	:	US
Telephone Number	:	609-345-8336
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR - FQHC
Name	:	MS. SANDY FESTA
Credential	:
Telephone Number	:	609-572-6051

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/30/2022

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