1154676799 NPI number — ARC HEALTH SYSTEMS, INC

Table of content: (NPI 1154676799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154676799 NPI number — ARC HEALTH SYSTEMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARC HEALTH SYSTEMS, 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:
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:
1154676799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 S 400 CENTER LN
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
DAWSONVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30534-6183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-216-4875
Provider Business Mailing Address Fax Number:
706-216-2732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 S 400 CENTER LN
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
DAWSONVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30534-6183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-216-4875
Provider Business Practice Location Address Fax Number:
706-216-2732
Provider Enumeration Date:
07/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ANNIS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-216-4875

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  2997 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35ZCBTW . This is a "MEDICARE ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com