Healthcare Provider Details

I. General information

NPI: 1932848587
Provider Name (Legal Business Name): ATLANTIC HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 CHESTNUT ST STE 5
LYNN MA
01904-2600
US

IV. Provider business mailing address

583 CHESTNUT ST STE 5
LYNN MA
01904-2600
US

V. Phone/Fax

Practice location:
  • Phone: 978-662-2050
  • Fax: 877-500-8285
Mailing address:
  • Phone: 978-662-2050
  • Fax: 877-500-8285

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 Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MAHRAY GEBREMICHAEL
Title or Position: CEO
Credential:
Phone: 978-662-2050