Provider Demographics
NPI:1386361566
Name:ATLANTIS HEALTH CARE GROUP PUERTO RICO, INC.
Entity type:Organization
Organization Name:ATLANTIS HEALTH CARE GROUP PUERTO RICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-292-7979
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:ST JUST STATION
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1350
Mailing Address - Country:US
Mailing Address - Phone:787-292-7979
Mailing Address - Fax:787-292-7999
Practice Address - Street 1:YAUCO PLAZA
Practice Address - Street 2:CARR. 128 KM. 0.2
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-292-7979
Practice Address - Fax:787-292-7999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN ALLIANCE DIALYSIS HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-27
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21-028OtherCON