MEDICARE: THE ARC OF BERGENA AND PASSAIC COUNTIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1376058867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARC OF BERGENA AND PASSAIC COUNTIES, INC.

Provider Business Mailing Address
First Line	:	223 MOORE ST
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-7402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 VERNON CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6544
Country	:	US
Telephone Number	:	862-221-9558
Fax Number	:

Authorized Official
Title or Position	:	CFO/VICE PRESIDENT
Name	:	CATHERINE PESCATORE
Credential	:
Telephone Number	:	201-343-0322

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	12/06/2017

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