Provider Demographics
NPI:1013683440
Name:ARK PROVISION ENTERPRISES, INC.
Entity Type:Organization
Organization Name:ARK PROVISION ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-655-9992
Mailing Address - Street 1:17333 NW 62ND PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4502
Mailing Address - Country:US
Mailing Address - Phone:305-826-3256
Mailing Address - Fax:
Practice Address - Street 1:5911 NW 173RD DR UNIT 11
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5122
Practice Address - Country:US
Practice Address - Phone:786-655-9992
Practice Address - Fax:786-734-8142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARK PROVISION ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities