Healthcare Provider Details

I. General information

NPI: 1003976705
Provider Name (Legal Business Name): ATLANTIC HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 S 20TH AVE STE A
SAFFORD AZ
85546-3378
US

IV. Provider business mailing address

885 PENNIMAN AVE UNIT 6426
PLYMOUTH MI
48170-7722
US

V. Phone/Fax

Practice location:
  • Phone: 928-792-4354
  • Fax:
Mailing address:
  • Phone: 888-891-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA4225
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberL13170568
License Number StateAZ

VIII. Authorized Official

Name: KRISTI JACKSON
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential:
Phone: 941-257-4285