1124044714 NPI number — ARCADIA HEALTH SERVICES, IC.

Table of content: (NPI 1124044714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124044714 NPI number — ARCADIA HEALTH SERVICES, IC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCADIA HEALTH SERVICES, IC.
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:
6
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:
1124044714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20750 CIVIC CENTER DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-4152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-733-8427
Provider Business Mailing Address Fax Number:
248-352-5189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 W FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47712-5109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-423-4327
Provider Business Practice Location Address Fax Number:
812-423-4634
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPARLING
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
800-733-8427

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200116110B . This is a "MED WAIVER PROGRAM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 750106 . This is a "SW IN REG COUNCIL ON AGIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200397640A . This is a "MEDICAID AGED & DISABLED" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200397640A . This is a "MEDICAID TBI WAIVER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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