Provider Demographics
NPI:1497294078
Name:DOUBLE ARC
Entity Type:Organization
Organization Name:DOUBLE ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOSSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-724-1370
Mailing Address - Street 1:5800 MONROE ST
Mailing Address - Street 2:BUILDING F-5
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-724-1370
Mailing Address - Fax:419-724-1372
Practice Address - Street 1:5800 MONROE ST
Practice Address - Street 2:BUILDING F-5
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2263
Practice Address - Country:US
Practice Address - Phone:419-724-1370
Practice Address - Fax:419-724-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
OH251V0000X251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable