Provider Demographics
NPI:1821015777
Name:ARC OF BRADFORD COUNTY INC
Entity Type:Organization
Organization Name:ARC OF BRADFORD COUNTY INC
Other - Org Name:THE ARC OF BRADFORD COUNTY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-964-7699
Mailing Address - Street 1:1351 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-4506
Mailing Address - Country:US
Mailing Address - Phone:904-964-7699
Mailing Address - Fax:904-964-7215
Practice Address - Street 1:1351 S WATER ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4506
Practice Address - Country:US
Practice Address - Phone:904-964-7699
Practice Address - Fax:904-964-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023509196Medicaid
FL023509198Medicaid