Provider Demographics
NPI:1194935213
Name:THE ARC OF SOUTHWEST WASHINGTON
Entity type:Organization
Organization Name:THE ARC OF SOUTHWEST WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-254-1562
Mailing Address - Street 1:P.O. BOX 2608
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668
Mailing Address - Country:US
Mailing Address - Phone:360-254-1562
Mailing Address - Fax:360-759-4921
Practice Address - Street 1:101 E 8TH STREET
Practice Address - Street 2:STE 220
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-254-1562
Practice Address - Fax:360-759-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253Z00000X
WA601138292251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7104771Medicaid
WA1026234Medicaid