Provider Demographics
NPI:1013269992
Name:THE ARC OF MACON
Entity Type:Organization
Organization Name:THE ARC OF MACON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-477-7764
Mailing Address - Street 1:4664 SHERATON DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1322
Mailing Address - Country:US
Mailing Address - Phone:478-477-7764
Mailing Address - Fax:478-477-8824
Practice Address - Street 1:4664 SHERATON DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1322
Practice Address - Country:US
Practice Address - Phone:478-477-7764
Practice Address - Fax:478-477-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-R-0040253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care