Healthcare Provider Details

I. General information

NPI: 1568764348
Provider Name (Legal Business Name): ATLANTIC HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 N. UNIVERSITY DRIVE SUITE 2415
CORAL SPRINGS FL
33065
US

IV. Provider business mailing address

2415 N UNIVERSITY DR
CORAL SPRINGS FL
33065-5123
US

V. Phone/Fax

Practice location:
  • Phone: 954-363-1363
  • Fax: 888-896-6607
Mailing address:
  • Phone: 954-363-1363
  • Fax: 888-896-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JACKELINE PLACENCIA
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 954-363-1363