Healthcare Provider Details

I. General information

NPI: 1184849606
Provider Name (Legal Business Name): NORTHEAST ARC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE WAY
DANVERS MA
01923-3626
US

IV. Provider business mailing address

1 SOUTHSIDE RD
DANVERS MA
01923-1408
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7570
  • Fax: 978-777-6149
Mailing address:
  • Phone: 978-762-4878
  • Fax: 978-777-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA PARK
Title or Position: CFO
Credential:
Phone: 978-624-2445