Provider Demographics
NPI:1851388185
Name:THE ARC OF ST. LUCIE COUNTY, INC.
Entity Type:Organization
Organization Name:THE ARC OF ST. LUCIE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-468-7879
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34954-1016
Mailing Address - Country:US
Mailing Address - Phone:772-468-7879
Mailing Address - Fax:772-465-7050
Practice Address - Street 1:705 KITTERMAN RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34952-9018
Practice Address - Country:US
Practice Address - Phone:772-466-7957
Practice Address - Fax:772-466-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8587320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZH238OtherS.A.M.H. CONTRACT