1093194623 NPI number — THE ARC OF MONMOUTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093194623 NPI number — THE ARC OF MONMOUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ARC OF MONMOUTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRANCHES ACHIEVEMENT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093194623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
395 WARBURTON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BRANCH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07740-6806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-229-4414
Provider Business Mailing Address Fax Number:
732-222-3567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
395 WARBURTON PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BRANCH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07740-6806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-229-4414
Provider Business Practice Location Address Fax Number:
732-222-3567
Provider Enumeration Date:
05/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ANGEL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
732-493-1919

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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