Provider Demographics
NPI:1285777573
Name:VITAS HEALTHCARE CORPORATION ATLANTIC
Entity type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION ATLANTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-373-4141
Mailing Address - Street 1:3046 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6547
Mailing Address - Country:US
Mailing Address - Phone:305-374-4143
Mailing Address - Fax:305-350-6993
Practice Address - Street 1:521 FELLOWSHIP RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3413
Practice Address - Country:US
Practice Address - Phone:856-778-0222
Practice Address - Fax:856-788-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23091251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0015008Medicaid
NJ31-1557Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ0015008Medicaid