1851388185 NPI number — THE ARC OF ST. LUCIE COUNTY, INC.

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 1851388185 NPI number — THE ARC OF ST. LUCIE COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF ST. LUCIE COUNTY, 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:
1851388185
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:
PO BOX 1016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT PIERCE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34954-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-468-7879
Provider Business Mailing Address Fax Number:
772-465-7050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 KITTERMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952-9018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-466-7957
Provider Business Practice Location Address Fax Number:
772-466-7957
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
772-468-7879

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  8587 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZH238 . This is a "S.A.M.H. CONTRACT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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