Provider Demographics
NPI:1215353370
Name:ARLINGTON ADULT RESIDENTIAL FACILITY, INC.
Entity type:Organization
Organization Name:ARLINGTON ADULT RESIDENTIAL FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMMEL
Authorized Official - Middle Name:PAR
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-725-6600
Mailing Address - Street 1:6300 ARLINGTON EXPY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7144
Mailing Address - Country:US
Mailing Address - Phone:904-725-6600
Mailing Address - Fax:904-725-7799
Practice Address - Street 1:6300 ARLINGTON EXPY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7144
Practice Address - Country:US
Practice Address - Phone:904-725-6600
Practice Address - Fax:904-725-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL53603104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140127100Medicaid