Basic Information
| Provider Information | |||||||||
| NPI: | 1285776385 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARC SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AZELIA GARDENS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2448 | ||||||||
| Address2: | |||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280022448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049833911 | ||||||||
| FaxNumber: | 7049825279 | ||||||||
| Practice Location | |||||||||
| Address1: | 4331 BELCHER ST | ||||||||
| Address2: | |||||||||
| City: | FARMVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278281366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527532091 | ||||||||
| FaxNumber: | 2527532257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASST. EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7049833911 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 8300725 | 05 | NC | MEDICAID |