Provider Demographics
NPI:1720200231
Name:SOUTHERN WORCESTER COUNTY ARC INC
Entity Type:Organization
Organization Name:SOUTHERN WORCESTER COUNTY ARC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-764-4085
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:100 FOSTER ST
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0066
Mailing Address - Country:US
Mailing Address - Phone:508-764-4085
Mailing Address - Fax:508-765-0255
Practice Address - Street 1:40 WEST ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1622
Practice Address - Country:US
Practice Address - Phone:508-764-4085
Practice Address - Fax:508-765-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300148Medicaid