Provider Demographics
NPI:1982098257
Name:ATLANTIS CBAS, INC
Entity type:Organization
Organization Name:ATLANTIS CBAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUBA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:310-536-6511
Mailing Address - Street 1:11813 RUNNYMEDE ST
Mailing Address - Street 2:#34
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3218
Mailing Address - Country:US
Mailing Address - Phone:310-536-6511
Mailing Address - Fax:323-978-2857
Practice Address - Street 1:5350 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:310-536-6511
Practice Address - Fax:323-978-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care