Provider Demographics
NPI:1235916313
Name:ARC ADVANCED RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:ARC ADVANCED RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CIPORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-598-6225
Mailing Address - Street 1:24725 GREENFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3059
Mailing Address - Country:US
Mailing Address - Phone:845-598-6225
Mailing Address - Fax:877-202-3150
Practice Address - Street 1:7076 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1500
Practice Address - Country:US
Practice Address - Phone:845-598-6225
Practice Address - Fax:877-202-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility