Provider Demographics
NPI:1972517738
Name:A.R.C. OF JACKSONVILLE, LTD
Entity Type:Organization
Organization Name:A.R.C. OF JACKSONVILLE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-243-6405
Mailing Address - Street 1:1320 TENDICK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3121
Mailing Address - Country:US
Mailing Address - Phone:217-243-6405
Mailing Address - Fax:217-245-1449
Practice Address - Street 1:1320 TENDICK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3121
Practice Address - Country:US
Practice Address - Phone:217-243-6405
Practice Address - Fax:217-245-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0032938313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility