Provider Demographics
NPI:1003203506
Name:ARCH CREEK SENIOR CARE SERVICES INCORPORATED
Entity Type:Organization
Organization Name:ARCH CREEK SENIOR CARE SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:LANNETTE
Authorized Official - Last Name:STURRUP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-916-0661
Mailing Address - Street 1:2065 NE 163 STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-944-0663
Mailing Address - Fax:305-944-0662
Practice Address - Street 1:13899 BISCAYNE BLVD
Practice Address - Street 2:SUITE 228
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33181-1600
Practice Address - Country:US
Practice Address - Phone:786-916-0661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233757253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care