Basic Information
Provider Information
NPI: 1588602031
EntityType: 2
ReplacementNPI:  
OrganizationName: ARC THERAPY SERVICES LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BROOKDALE THERAPY OAK PARK
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 WESTWOOD PLACE
Address2: SUITE 400
City: BRENTWOOD
State: TN
PostalCode: 370275057
CountryCode: US
TelephoneNumber: 6152212250
FaxNumber:  
Practice Location
Address1: 1111 ONTARIO ST
Address2:  
City: OAK PARK
State: IL
PostalCode: 603021939
CountryCode: US
TelephoneNumber: 7083831111
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2006
LastUpdateDate: 04/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: EVANS
AuthorizedOfficialFirstName: DONNIS
AuthorizedOfficialMiddleName: M.
AuthorizedOfficialTitleorPosition: MANAGER, REGULATORY PRACTICES
AuthorizedOfficialTelephone: 6152780367
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: BROOKDALE SENIOR LIVING
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QP2000X  Y Ambulatory Health Care FacilitiesClinic/CenterPhysical Therapy

No ID Information.


Home