MEDICARE: ARC OF JACKSONVILLE, LTD

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	313M00000X	Nursing Facility/Intermediate Care Facility	14E245	IL

General Provider Information

NPI Number	:	1770581191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARC OF JACKSONVILLE, LTD

Provider Business Mailing Address
First Line	:	1320 TENDICK ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3121
Country	:	US
Telephone Number	:	217-243-6405
Fax Number	:	217-243-2056

Provider Business Practice Location Address
First Line	:	1320 TENDICK ST
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-3121
Country	:	US
Telephone Number	:	217-243-6405
Fax Number	:	217-243-2056

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MELVIN SIEGEL
Credential	:
Telephone Number	:	847-679-0100

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	08/22/2020

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