Healthcare Provider Details

I. General information

NPI: 1902442916
Provider Name (Legal Business Name): ATLANTIS SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 NW 40TH CT
OAKLAND PARK FL
33309-5138
US

IV. Provider business mailing address

10515 VERSAILLES BLVD
WELLINGTON FL
33449-8084
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-8857
  • Fax: 954-440-4761
Mailing address:
  • Phone: 561-789-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. SUHAN JUNAID
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-789-7924