Provider Demographics
NPI:1003078247
Name:THE ARC OF FOND DU LAC INC
Entity Type:Organization
Organization Name:THE ARC OF FOND DU LAC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIRSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-923-3810
Mailing Address - Street 1:500 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-1943
Mailing Address - Country:US
Mailing Address - Phone:920-923-3810
Mailing Address - Fax:920-923-3038
Practice Address - Street 1:500 N PARK AVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-1943
Practice Address - Country:US
Practice Address - Phone:920-923-3810
Practice Address - Fax:920-923-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle