MEDICARE: THE ARC OF ATLANTIC COUNTY, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1861738874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARC OF ATLANTIC COUNTY, INC.

Provider Business Mailing Address
First Line	:	6550 DELILAH RD STE 101
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-5102
Country	:	US
Telephone Number	:	609-485-0800
Fax Number	:	609-407-6282

Provider Business Practice Location Address
First Line	:	6550 DELILAH RD STE 101
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-5102
Country	:	US
Telephone Number	:	609-485-0800
Fax Number	:	609-407-6282

Authorized Official
Title or Position	:	CFO
Name	:	MS. JILL A. LEMON
Credential	:
Telephone Number	:	609-485-0800

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	12/19/2012

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