Healthcare Provider Details

I. General information

NPI: 1215987771
Provider Name (Legal Business Name): ATLANTICARE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 BACHARACH BLVD
ATLANTIC CITY NJ
08401
US

IV. Provider business mailing address

65 W JIMMIE LEEDS RD ATTN FINANCE J HOKE
POMONA NJ
08205
US

V. Phone/Fax

Practice location:
  • Phone: 609-344-5714
  • Fax: 609-345-0775
Mailing address:
  • Phone: 609-569-7303
  • Fax: 609-272-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number23265
License Number StateNJ

VIII. Authorized Official

Name: MS. SANDY FESTA
Title or Position: EXECUTIVE DIRECTOR FQHC
Credential:
Phone: 609-572-6051