Provider Demographics
NPI:1821203365
Name:MINUTE MAN ARC FOR HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:MINUTE MAN ARC FOR HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-287-7914
Mailing Address - Street 1:130C BAKER AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2121
Mailing Address - Country:US
Mailing Address - Phone:978-287-7900
Mailing Address - Fax:978-287-7979
Practice Address - Street 1:130C BAKER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2121
Practice Address - Country:US
Practice Address - Phone:978-287-7900
Practice Address - Fax:978-287-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300652Medicare ID - Type Unspecified