- Enrollment id
- O20040421000054
- Enrollment state
- DE
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1821131756
- Multiple npi flag
- N
- Ccn
- 071533
- Associate id
- 5698684405
- Organization name
- VITAS HEALTHCARE CORPORATION ATLANTIC
- Incorporation date
- 1993-05-04
- Incorporation state
- DE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 199 PARK ROAD EXTENSION
- Address line 2
- SUITE 102
- City
- MIDDLEBURY
- State
- CT
- Zip code
- 06762