=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699545517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTIC PALLIATIVE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2024
-----------------------------------------------------
Last Update Date | 01/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16600 WOODRUFF AVE STE 209-A
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-539-6886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16600 WOODRUFF AVE STE 209-A
-----------------------------------------------------
City | BELLFLOWER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90706-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-539-6886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CEO
-----------------------------------------------------
Name | CRISTINE A NUGUID
-----------------------------------------------------
Credential | BSHC AND MS IN ADM
-----------------------------------------------------
Telephone | 831-539-6886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------