MEDICARE: THE ARC OF ATLANTIC COUNTY, INC.

Medicare Provider Information

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		NJ

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1881107761
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 TWP
State	:	NJ
Zip	:	08234-5102
Country	:	US
Telephone Number	:	609-485-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 ATLANTIC AVE APT 208
Second Line	:
City	:	ATLANTIC CITY
State	:	NJ
Zip	:	08401-6017
Country	:	US
Telephone Number	:	609-485-0800
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	REBECCA REED
Credential	:
Telephone Number	:	609-485-0800

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

3850 ATLANTIC AVE APT 207
ATLANTIC CITY, NJ
08401-6017