Healthcare Provider Details

I. General information

NPI: 1003078247
Provider Name (Legal Business Name): THE ARC OF FOND DU LAC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N PARK AVE
FOND DU LAC WI
54935-1943
US

IV. Provider business mailing address

500 N PARK AVE
FOND DU LAC WI
54935-1943
US

V. Phone/Fax

Practice location:
  • Phone: 920-923-3810
  • Fax: 920-923-3038
Mailing address:
  • Phone: 920-923-3810
  • Fax: 920-923-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN P KIRSCHNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 920-923-3810