Provider Demographics
NPI:1285916114
Name:THE ARC OF WALTON COUNTY, INC.
Entity type:Organization
Organization Name:THE ARC OF WALTON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-892-5013
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32435-0813
Mailing Address - Country:US
Mailing Address - Phone:850-892-5013
Mailing Address - Fax:850-892-7895
Practice Address - Street 1:1408A HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-3817
Practice Address - Country:US
Practice Address - Phone:850-892-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL024511998251C00000X, 253Z00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002815900Medicaid
FL024511996OtherMEDICAID WAIVER
FL024511998OtherMEDICAID WAIVER