Provider Demographics
NPI:1275584963
Name:ARC PROFESSIONAL SERVICES, INC
Entity Type:Organization
Organization Name:ARC PROFESSIONAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-5355
Mailing Address - Street 1:14337 SW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6006
Mailing Address - Country:US
Mailing Address - Phone:305-463-5355
Mailing Address - Fax:305-779-4395
Practice Address - Street 1:14337 SW 119TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6006
Practice Address - Country:US
Practice Address - Phone:305-463-5355
Practice Address - Fax:305-779-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL215710952251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650544900Medicaid
FL650544900Medicaid