| Organization Name: | ATLANTIS HEALTH CARE GROUP PUERTO RICO INC |
| NPI Number: | 1104907682 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RUBETTE HARFORD (PRESIDENT & CEO) |
| Mailing Address: | Calle Aniceto Diaz Interseccion 876 Expreso Trujillo Alto Trujillo Alto |
| State: | PR US |
| Postal Code: | 00978 |
| Phone Number: | 7872927979 |
| Fax Number: | 7872927999 |
| NPI Enumeration Date: | 10/18/2006 |
| NPI Last Update Date: | 07/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | LIC #23 CNC 05-260 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |