NPIMap

Organization Active NPI

Atlantic Hospice, Inc.

Doing business as Angelic Hospice

  • Community Based Hospice Care Agency
  • Pleasantville, NJ
National Provider Identifier
1194169995
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ATLANTIC HOSPICE, INC.
Doing business as
Angelic Hospice
Practice address
8025 Black Horse Pike Ste 501
Pleasantville, NJ 08232-2967
Phone
(609) 822-7979
Fax
(609) 822-7980
NPI assigned
Apr 23, 2013
Last updated
Sep 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dan Mikus
Title
Administrator
Phone
(609) 822-7979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

8025 Black Horse Pike Ste 501
Pleasantville, NJ 08232-2967

Mailing address

8025 Black Horse Pike Ste 501
Pleasantville, NJ 08232-2967
Phone (609) 822-7979

Other names 1

  • Angelic Hospice Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL http://www.angelic.health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140715002002 NJ Part A Provider - Hospice 9032334685 Practice locations: Pleasantville, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194169995. Details of each certification follow.

Hospice certification: CCN 311579

Legal name
ATLANTIC HOSPICE INC
Doing business as
ANGELIC HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 20, 2015
Last certification
May 10, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Enrollment address
8025 Black Horse Pike
Ste 501
Pleasantville, NJ 08232-2967

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Angelic HospiceCCN 311579 · All quality measures
Ownership
For-Profit
Certified
Mar 20, 2015
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Atlantic Hospice Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

802 Tilton Rd
Ste 100
Northfield, NJ 08225
Phone (609) 822-7979

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michael J Sperling Individual W-2 Managing EmployeeMD; Jul 1, 2019 50%
Leonard Koltman Individual 5% Or Greater Direct Ownership InterestPresident Sep 10, 2024 50%
Corporate OfficerPresident Jan 30, 2013 50%
Daniel Mikus Individual 5% Or Greater Direct Ownership InterestAdministrator Sep 10, 2024 50%
Corporate DirectorAdministrator Oct 2, 2017 50%
W-2 Managing EmployeeAd; Oct 2, 2017 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568160000000",
    "number": "1194169995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8025 BLACK HORSE PIKE STE 501",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082322967",
            "telephone_number": "609-822-7979",
            "fax_number": "609-822-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8025 BLACK HORSE PIKE STE 501",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082322967",
            "telephone_number": "609-822-7979",
            "fax_number": "609-822-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-23",
        "last_updated": "2019-09-11",
        "status": "A",
        "authorized_official_last_name": "MIKUS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "609-822-7979"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://www.angelic.health",
            "affiliation": "N",
            "address_1": "8025 Black Horse Pike Ste 501",
            "city": "Pleasantville",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "082322967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Angelic Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pleasantville, NJ

Sources for this page

Verify at the official NPI Registry.