MEDICARE: KADOSH ARC LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1891513834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KADOSH ARC LLC

Provider Business Mailing Address
First Line	:	1207 DELAWARE AVE # 3300
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 DELAWARE AVE # 3300
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4743
Country	:	US
Telephone Number	:	240-413-7993
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AGBOR ODI
Credential	:
Telephone Number	:	240-413-7993

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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