Healthcare Provider Details

I. General information

NPI: 1750921011
Provider Name (Legal Business Name): AMERITA SOUTH ATLANTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 SEMINOLE LN STE 103
CHARLOTTESVILLE VA
22901-8319
US

IV. Provider business mailing address

6912 S QUENTIN ST SUITE 50
CENTENNIAL CO
80112
US

V. Phone/Fax

Practice location:
  • Phone: 540-932-3000
  • Fax: 833-994-0850
Mailing address:
  • Phone: 720-282-5325
  • Fax: 877-676-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALEX KATEN
Title or Position: CFO
Credential:
Phone: 720-282-2377