Provider Demographics
NPI:1982877411
Name:ARC COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:ARC COMMUNITY SERVICES, INC.
Other - Org Name:ARC FOND DU LAC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF AODA SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-278-2300
Mailing Address - Street 1:17 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4155
Mailing Address - Country:US
Mailing Address - Phone:920-907-0813
Mailing Address - Fax:920-907-0826
Practice Address - Street 1:17 FOREST AVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4155
Practice Address - Country:US
Practice Address - Phone:920-907-0813
Practice Address - Fax:920-907-0826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARC COMMUNITY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2358251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43171121Medicaid