1760608699 NPI number — ARC BRIDGES, INC

Table of content: (NPI 1760608699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760608699 NPI number — ARC BRIDGES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARC BRIDGES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760608699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 W 35TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46408-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-884-1138
Provider Business Mailing Address Fax Number:
219-980-7315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 N KNOX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46403-2093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-939-0683
Provider Business Practice Location Address Fax Number:
219-980-7315
Provider Enumeration Date:
04/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
219-884-1138

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)