Healthcare Provider Details

I. General information

NPI: 1861513616
Provider Name (Legal Business Name): ARC BRIDGES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 W 35TH AVE
GARY IN
46408-1416
US

IV. Provider business mailing address

2650 W 35TH AVE
GARY IN
46408-1416
US

V. Phone/Fax

Practice location:
  • Phone: 219-884-1138
  • Fax: 219-980-7315
Mailing address:
  • Phone: 219-884-1138
  • Fax: 219-980-7315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: KRIS PROHL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-884-1138