Provider Demographics
NPI:1699234112
Name:ATLANTIS COORDINATED SERVICES LLC
Entity type:Organization
Organization Name:ATLANTIS COORDINATED SERVICES LLC
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:MORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-780-3093
Mailing Address - Street 1:1621 CARPENTER ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2005
Mailing Address - Country:US
Mailing Address - Phone:267-780-3093
Mailing Address - Fax:267-367-5550
Practice Address - Street 1:1621 CARPENTER ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2005
Practice Address - Country:US
Practice Address - Phone:267-780-3093
Practice Address - Fax:267-367-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035934700001Medicaid