Basic Information
| Provider Information | |||||||||
| NPI: | 1134145774 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARCADIA HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARCADIA HOME CARE & STAFFING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20750 CIVIC CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480764152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007338427 | ||||||||
| FaxNumber: | 2483525189 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 AUBURN DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168166706 | ||||||||
| FaxNumber: | 2168166981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 12/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | BURCHI | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8007338427 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARCADIA SERVICES, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 55-1818531 | 01 | OH | PDA WAIVER PROGRAM | OTHER | 497783 | 01 | OH | OH DEPT OF AGING | OTHER | 0849327 | 01 | OH | MEDICAID DISAB & MED FRAG | OTHER |