Provider Demographics
NPI:1598900060
Name:ATLANTIC HOME HEALTH AGENCY OF SOUTH FLORIDA, LLC
Entity type:Organization
Organization Name:ATLANTIC HOME HEALTH AGENCY OF SOUTH FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-733-1003
Mailing Address - Street 1:4655 SALISBURY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0957
Mailing Address - Country:US
Mailing Address - Phone:904-733-1003
Mailing Address - Fax:904-448-8855
Practice Address - Street 1:360 COLUMBIA DR STE 104
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1976
Practice Address - Country:US
Practice Address - Phone:561-447-6602
Practice Address - Fax:561-447-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2108489OtherCLIA
FL299994439OtherAHCA LICENSE - BRANCH
FL299993554OtherAHCA LICENSE - PARENT