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NPI Code Detail

MEDICARE: ARC CARRIAGE CLUB OF JACKSONVILLE, INC.

MEDICARE: ARC CARRIAGE CLUB OF JACKSONVILLE, INC.
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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1255633681
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARC CARRIAGE CLUB OF JACKSONVILLE, INC.
Provider Business Mailing Address
First Line : 6737 W WASHINGTON ST
Second Line : SUITE 2300
City : MILWAUKEE
State : WI
Zip : 53214-5647
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9601 SOUTHBROOK DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-0601
Country : US
Telephone Number : 904-641-7501
Fax Number : 904-646-4055
Authorized Official
Title or Position : CO-PRESIDENT
Name : MARK OHLENDORF
Credential :
Telephone Number : 414-918-5000
Provider Enumeration Date : 11/17/2010
Last Update Date : 11/17/2010

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Directions to “ARC CARRIAGE CLUB OF JACKSONVILLE, INC. ” Practice Location

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