Healthcare Provider Details

I. General information

NPI: 1508473745
Provider Name (Legal Business Name): ATLANTIC CARE SERVICES CLERMONT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15430 COUNTY ROAD 565A STE P
GROVELAND FL
34736-8243
US

IV. Provider business mailing address

15430 COUNTY ROAD 565A STE P
GROVELAND FL
34736-8243
US

V. Phone/Fax

Practice location:
  • Phone: 407-270-5501
  • Fax: 407-559-8971
Mailing address:
  • Phone: 407-270-5501
  • Fax: 407-559-8971

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON T COONS
Title or Position: OWNER
Credential:
Phone: 407-484-2972