Basic Information
Provider Information | |||||||||
NPI: | 1730450263 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ARC THERAPY SERVICES LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | BROOKDALE THERAPY BRISTOL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 111 WESTWOOD PL | ||||||||
Address2: | SUITE 400 | ||||||||
City: | BRENTWOOD | ||||||||
State: | TN | ||||||||
PostalCode: | 370275021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152212250 | ||||||||
FaxNumber: | 4142924868 | ||||||||
Practice Location | |||||||||
Address1: | 1 LIBERTY PL | ||||||||
Address2: |   | ||||||||
City: | BRISTOL | ||||||||
State: | VA | ||||||||
PostalCode: | 242012360 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2766691111 | ||||||||
FaxNumber: | 2765911370 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/13/2012 | ||||||||
LastUpdateDate: | 06/18/2021 | ||||||||
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: | 06/18/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.