Provider Demographics
NPI:1245741495
Name:ASSOC. FOR RETARDED CITIZENS. INC. GLOUCESTER COUNTY
Entity Type:Organization
Organization Name:ASSOC. FOR RETARDED CITIZENS. INC. GLOUCESTER COUNTY
Other - Org Name:THE ARC GLOUCESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-8648
Mailing Address - Street 1:1555 GATEWAY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-848-8648
Mailing Address - Fax:856-848-7753
Practice Address - Street 1:1 FAWN DRIVE
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-464-8223
Practice Address - Fax:856-464-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities