MEDICARE: ATLANTIC HEALTHCARE GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730116062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC HEALTHCARE GROUP INC

Provider Business Mailing Address
First Line	:	911 CREEL ST
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527-5001
Country	:	US
Telephone Number	:	843-488-4001
Fax Number	:	843-488-4005

Provider Business Practice Location Address
First Line	:	911 CREEL ST
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527-5001
Country	:	US
Telephone Number	:	843-488-4001
Fax Number	:	843-488-4005

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. STEPHEN KEMPSKI
Credential	:
Telephone Number	:	843-488-4001

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/05/2009

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