Provider Demographics
NPI:1316132509
Name:THE ARC TAMPA BAY, INC.
Entity type:Organization
Organization Name:THE ARC TAMPA BAY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIRACUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-799-3330
Mailing Address - Street 1:1501 N BELCHER RD
Mailing Address - Street 2:STE. 249
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1339
Mailing Address - Country:US
Mailing Address - Phone:727-799-3330
Mailing Address - Fax:727-799-4632
Practice Address - Street 1:1501 N BELCHER RD
Practice Address - Street 2:STE. 249
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1339
Practice Address - Country:US
Practice Address - Phone:727-799-3330
Practice Address - Fax:727-799-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL024020696251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC040231200Medicaid
FL024020696Medicaid