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General NPI Number Information
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NPI Number | 1376872929
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Entity Type | Organization
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Legal Business Name | ARC OF CLARK COUNTY
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 6511 NE 18TH ST
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City | VANCOUVER
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State | WA
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Zip | 98661-6869
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Country | US
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Telephone | 360-759-4917
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Fax | 360-759-4921
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Provider Business Mailing Address
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Address Line | PO BOX 2277
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City | VANCOUVER
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State | WA
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Zip | 98668-2277
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Country | US
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Telephone | 360-759-4917
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Fax | 360-759-4921
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Authorized Official
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Title or Position | MEDICAL BILLING SPECIALIST
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Name | MRS. TRACYLYN BROERSMA
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Credential |
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Telephone | 360-759-4917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | PT60116751
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License Number State | WA
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