Provider Demographics
NPI:1295865350
Name:SPRINGFIELD ARC, INC.
Entity Type:Organization
Organization Name:SPRINGFIELD ARC, INC.
Other - Org Name:SPRINGFIELD ASSOCIATION FOR RETARDED CITIZENS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-793-2100
Mailing Address - Street 1:232 N BRUNS LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4613
Mailing Address - Country:US
Mailing Address - Phone:217-793-2100
Mailing Address - Fax:217-793-2127
Practice Address - Street 1:232 N BRUNS LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4613
Practice Address - Country:US
Practice Address - Phone:217-793-2100
Practice Address - Fax:217-793-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities