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General NPI Number Information
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NPI Number | 1760756738
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Entity Type | Organization
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Legal Business Name | MANASOTA ARC
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 4211 36TH AVE E
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City | PALMETTO
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State | FL
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Zip | 34221-8968
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Country | US
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Telephone | 941-721-7684
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 36TH AVE E
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City | PALMETTO
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State | FL
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Zip | 34221-8968
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Country | US
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Telephone | 941-721-7684
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DIERDRA WALKER
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Credential |
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Telephone | 727-410-7859
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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