Provider Demographics
NPI:1215987771
Name:ATLANTICARE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:ATLANTICARE HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR FQHC
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-572-6051
Mailing Address - Street 1:65 W JIMMIE LEEDS RD
Mailing Address - Street 2:ATTN FINANCE J HOKE
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-569-7303
Mailing Address - Fax:609-272-6251
Practice Address - Street 1:2009 BACHARACH BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-344-5714
Practice Address - Fax:609-345-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23265261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31D103000OtherCMS-CLIA
NJ0028592Medicaid
NJ60019117OtherHORIZON HEALTH HMO
NJ080182Medicare ID - Type Unspecified
NJ0028592Medicaid