Provider Demographics
NPI:1710541479
Name:NORTHEAST ARC
Entity Type:Organization
Organization Name:NORTHEAST ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DAY HABILITATION
Authorized Official - Prefix:
Authorized Official - First Name:FUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-624-2629
Mailing Address - Street 1:1 SOUTHSIDE RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1408
Mailing Address - Country:US
Mailing Address - Phone:978-762-4878
Mailing Address - Fax:978-777-6149
Practice Address - Street 1:100 INDEPENDENCE WAY STE W150
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3626
Practice Address - Country:US
Practice Address - Phone:978-750-6001
Practice Address - Fax:978-774-4478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ARC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services