Provider Demographics
NPI:1790565646
Name:ARC THERAPY
Entity Type:Organization
Organization Name:ARC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:AYSBELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZOS COSTALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-379-4625
Mailing Address - Street 1:12351 SW 256TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7048
Mailing Address - Country:US
Mailing Address - Phone:561-379-4625
Mailing Address - Fax:
Practice Address - Street 1:5900 W 20TH AVE STE C
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2604
Practice Address - Country:US
Practice Address - Phone:561-379-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty