Healthcare Provider Details

I. General information

NPI: 1285916114
Provider Name (Legal Business Name): THE ARC OF WALTON COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408A HIGHWAY 83 N
DEFUNIAK SPRINGS FL
32433-3817
US

IV. Provider business mailing address

PO BOX 813
DEFUNIAK SPRINGS FL
32435-0813
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-5013
  • Fax:
Mailing address:
  • Phone: 850-892-5013
  • Fax: 850-892-7895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number024511998
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number024511998
License Number StateFL

VIII. Authorized Official

Name: MS. KIMBERLY J LONAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-892-5013