Healthcare Provider Details

I. General information

NPI: 1740954585
Provider Name (Legal Business Name): ATLANTIC TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SW 12TH AVE
POMPANO BEACH FL
33069-3502
US

IV. Provider business mailing address

380 SW 12TH AVE
POMPANO BEACH FL
33069-3502
US

V. Phone/Fax

Practice location:
  • Phone: 410-615-4312
  • Fax:
Mailing address:
  • Phone: 410-615-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: OLUWAFEMI SHODIPE
Title or Position: CEO
Credential: RN
Phone: 410-615-4312