Healthcare Provider Details

I. General information

NPI: 1922089119
Provider Name (Legal Business Name): ATLAS CARE ENTERPRISES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S FICKETT ST
LOS ANGELES CA
90033-4017
US

IV. Provider business mailing address

101 S FICKETT ST
LOS ANGELES CA
90033-4017
US

V. Phone/Fax

Practice location:
  • Phone: 323-261-8108
  • Fax: 323-261-8213
Mailing address:
  • Phone: 323-261-8108
  • Fax: 323-261-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000035
License Number StateCA

VIII. Authorized Official

Name: MR. FIL V CONSOLACION
Title or Position: ADMINISTRATOR
Credential: NHA5683
Phone: 323-261-8108