MEDICARE: THE ARC OF ESSEX 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	:	1881074714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ARC OF ESSEX COUNTY, INC.

Provider Business Mailing Address
First Line	:	123 NAYLON AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1005
Country	:	US
Telephone Number	:	973-535-1181
Fax Number	:	973-422-0359

Provider Business Practice Location Address
First Line	:	160 BLOOMFIELD AVE APT A
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2711
Country	:	US
Telephone Number	:	973-535-1181
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. LINDA LUCAS
Credential	:
Telephone Number	:	973-535-1181

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	07/21/2022

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