1306212287 NPI number — ASSOC. FOR RETARDED CITIZENS, INC. GOUCESTER COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306212287 NPI number — ASSOC. FOR RETARDED CITIZENS, INC. GOUCESTER COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOC. FOR RETARDED CITIZENS, INC. GOUCESTER COUNTY
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:
THE ARC GLOUCESTER
Provider Other Organization Name Type Code:
3
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:
1306212287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 GATEWAY BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DEPTFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-848-8648
Provider Business Mailing Address Fax Number:
856-848-7753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 HARMONY RD. SUITE 3
Provider Second Line Business Practice Location Address:
GIBBSTOWN ATS IV
Provider Business Practice Location Address City Name:
GIBBSTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-224-0383
Provider Business Practice Location Address Fax Number:
856-224-0445
Provider Enumeration Date:
08/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
ANA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
856-848-8648

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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