Basic Information
Provider Information
NPI: 1154579662
EntityType: 2
ReplacementNPI:  
OrganizationName: ARC THERAPY SERVICES LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: NURSE ON CALL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 PARK PLZ
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372036527
CountryCode: US
TelephoneNumber: 6153449551
FaxNumber:  
Practice Location
Address1: 4012 COMMONS DRIVE
Address2: SUITE 224-C
City: DESTIN
State: FL
PostalCode: 325418422
CountryCode: US
TelephoneNumber: 8506502326
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/09/2008
LastUpdateDate: 04/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: EVANS
AuthorizedOfficialFirstName: DONNIS
AuthorizedOfficialMiddleName: M.
AuthorizedOfficialTitleorPosition: MANAGER, REGULATORY PRACTICES
AuthorizedOfficialTelephone: 6152780367
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: HEALTH AT HOME-BHS, LLC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X299993615FLY AgenciesHome Health 

No ID Information.


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