MEDICARE: ARCH SUPPORT RESIDENTIAL SERVICES

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1699076034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCH SUPPORT RESIDENTIAL SERVICES

Provider Business Mailing Address
First Line	:	118 LONGSTREET AVE
Second Line	:
City	:	HIGHLAND SPRINGS
State	:	VA
Zip	:	23075-1141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 LONGSTREET AVE
Second Line	:
City	:	HIGHLAND SPRINGS
State	:	VA
Zip	:	23075-1141
Country	:	US
Telephone Number	:	804-433-3827
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANTHONY V ARCHER
Credential	:
Telephone Number	:	804-399-9709

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	11/16/2010

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