MEDICARE: THEARC, WARREN COUNTY CHAPTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	GH171	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073051025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEARC, WARREN COUNTY CHAPTER

Provider Business Mailing Address
First Line	:	319 W WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	NJ
Zip	:	07882-2157
Country	:	US
Telephone Number	:	908-689-7525
Fax Number	:	908-689-4898

Provider Business Practice Location Address
First Line	:	431 HURLEY DR
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-1835
Country	:	US
Telephone Number	:	908-850-0236
Fax Number	:	908-852-0784

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN DAVID WHITEHEAD
Credential	:
Telephone Number	:	908-689-7525

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	06/22/2026

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