Provider Demographics
NPI:1619521432
Name:A1A - ARC OF JACKSONVILLE, LLC
Entity Type:Organization
Organization Name:A1A - ARC OF JACKSONVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-394-2890
Mailing Address - Street 1:10752 DEERWOOD PARK BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4848
Mailing Address - Country:US
Mailing Address - Phone:904-394-2893
Mailing Address - Fax:
Practice Address - Street 1:1241 ONSLOW PINES RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4366
Practice Address - Country:US
Practice Address - Phone:910-347-3092
Practice Address - Fax:910-347-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC310400000XMedicaid