Provider Demographics
NPI:1871702266
Name:NORTHEAST ARC, INC.
Entity type:Organization
Organization Name:NORTHEAST ARC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-624-2445
Mailing Address - Street 1:64 HOLTEN ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1973
Mailing Address - Country:US
Mailing Address - Phone:978-762-4878
Mailing Address - Fax:978-777-6149
Practice Address - Street 1:64 HOLTEN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1973
Practice Address - Country:US
Practice Address - Phone:978-762-4878
Practice Address - Fax:978-777-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1906577Medicaid