Atlantic in-Home Care, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

NR30211036 Issued in FL

Legal business name

ATLANTIC IN-HOME CARE, LLC

Practice address

240 NW Peacock Blvd Ste 304
Port Saint Lucie, FL 34986-2274

Phone

(772) 462-6707

Fax

(772) 462-6706

NPI assigned

Sep 10, 2015

Organization subpart

No

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

Authorized official

Name

Gary Evans

Title

Cfo

Phone

(772) 462-6707

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1548638216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 NW PEACOCK BLVD STE 304",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349862274",
            "telephone_number": "772-462-6707",
            "fax_number": "772-463-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 NW PEACOCK BLVD STE 304",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862274",
            "telephone_number": "772-462-6707",
            "fax_number": "772-462-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC IN-HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-10",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "772-462-6707"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "FL",
            "license": "NR30211036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016181800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.