Provider Demographics
NPI:1790203594
Name:THE ARC, WARREN COUNTY CHAPTER
Entity Type:Organization
Organization Name:THE ARC, WARREN COUNTY CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PRUZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-689-7525
Mailing Address - Street 1:319 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2157
Mailing Address - Country:US
Mailing Address - Phone:908-689-7525
Mailing Address - Fax:908-689-4898
Practice Address - Street 1:680 CORLISS AVE APT 1A
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1640
Practice Address - Country:US
Practice Address - Phone:908-213-2928
Practice Address - Fax:908-454-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH2061320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1710229778Medicaid