Healthcare Provider Details

I. General information

NPI: 1083127880
Provider Name (Legal Business Name): THE ARC SHIAWASSEE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 WEST M-21
OWOSSO MI
48867
US

IV. Provider business mailing address

PO BOX 63 1905 WEST M-21
OWOSSO MI
48867
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-7377
  • Fax: 989-725-6113
Mailing address:
  • Phone: 989-723-7377
  • Fax: 989-725-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: LYNN KOVALIK GRUBB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-723-7377