Provider Demographics
NPI:1588148829
Name:ATLANTIS CAREGIVING CORPORATION
Entity type:Organization
Organization Name:ATLANTIS CAREGIVING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTER AGENT/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LARMANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-453-0944
Mailing Address - Street 1:3835 SW 185TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1553
Mailing Address - Country:US
Mailing Address - Phone:503-453-0944
Mailing Address - Fax:
Practice Address - Street 1:3835 SW 185TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-1553
Practice Address - Country:US
Practice Address - Phone:503-453-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-22
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR526725Medicaid