Provider Demographics
NPI:1194730986
Name:RIDGE AREA ARC INC
Entity type:Organization
Organization Name:RIDGE AREA ARC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:BORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-452-1295
Mailing Address - Street 1:4352 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9300
Mailing Address - Country:US
Mailing Address - Phone:863-452-1295
Mailing Address - Fax:863-452-5244
Practice Address - Street 1:4352 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9300
Practice Address - Country:US
Practice Address - Phone:863-452-1295
Practice Address - Fax:863-452-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024659098Medicaid
FL024659096Medicaid