Healthcare Provider Details

I. General information

NPI: 1194730986
Provider Name (Legal Business Name): RIDGE AREA ARC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 INDEPENDENCE ST
AVON PARK FL
33825-9300
US

IV. Provider business mailing address

4352 INDEPENDENCE ST
AVON PARK FL
33825-9300
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-1295
  • Fax: 863-452-5244
Mailing address:
  • Phone: 863-452-1295
  • Fax: 863-452-5244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN SHANNON BORDER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 863-452-1295