Healthcare Provider Details

I. General information

NPI: 1124424080
Provider Name (Legal Business Name): THE ARC TAMPA BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N BELCHER RD
CLEARWATER FL
33765-1339
US

IV. Provider business mailing address

1501 N BELCHER RD STE. 249
CLEARWATER FL
33765-1339
US

V. Phone/Fax

Practice location:
  • Phone: 727-799-3330
  • Fax: 727-799-4632
Mailing address:
  • Phone: 727-799-3330
  • Fax: 727-799-4632

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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIAN LORRAINE CLINE
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 727-799-3330