MEDICARE: ARC OF ESSEX COUNTY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417477134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARC OF ESSEX COUNTY

Provider Business Mailing Address
First Line	:	123 NAYLON AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1005
Country	:	US
Telephone Number	:	973-535-1181
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 BLOOMFIELD AVE APT B
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2711
Country	:	US
Telephone Number	:	973-535-1181
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. LINDA LUCAS
Credential	:
Telephone Number	:	973-535-1181

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	06/23/2017

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Directions to “ARC OF ESSEX COUNTY ” Practice Location

Language	Start Address	Practice Location

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