Healthcare Provider Details

I. General information

NPI: 1346227055
Provider Name (Legal Business Name): ATLANTIC HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 15TH AVENUE
VERO BEACH FL
32960
US

IV. Provider business mailing address

3663 15TH AVENUE
VERO BEACH FL
32960
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-2552
  • Fax: 772-567-8929
Mailing address:
  • Phone: 772-567-2552
  • Fax: 772-567-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1573096
License Number StateFL

VIII. Authorized Official

Name: MR. BRIAN REYNOLDS
Title or Position: CEO
Credential:
Phone: 410-513-8738