=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497704845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTICARE HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 11/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 929 ATLANTIC AVE
-----------------------------------------------------
City | ATLANTIC CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-348-4070
-----------------------------------------------------
Fax | 609-348-1122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 ATLANTIC AVE STE 1125
-----------------------------------------------------
City | ATLANTIC CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08401-7001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-572-6002
-----------------------------------------------------
Fax | 609-572-6001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCE/CFO
-----------------------------------------------------
Name | MR. CHRISTOPHER CARL APGAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-572-6006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------