MEDICARE: THE ARC, OCEAN COUNTY CHAPTER, 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	:	1629585518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARC, OCEAN COUNTY CHAPTER, INC.

Provider Business Mailing Address
First Line	:	815 CEDARBRIDGE AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4932
Country	:	US
Telephone Number	:	732-363-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 NEWPORT CT
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-2039
Country	:	US
Telephone Number	:	732-363-3335
Fax Number	:	732-604-6432

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	SALLY STONEHAM
Credential	:
Telephone Number	:	732-363-3335

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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