MEDICARE: ARQUE TLC 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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1598128258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARQUE TLC INC.

Provider Business Mailing Address
First Line	:	2960 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5826
Country	:	US
Telephone Number	:	562-221-0890
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN W BREWER
Credential	:
Telephone Number	:	562-221-0890

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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