Provider Demographics
NPI:1427484252
Name:ARC OF LIFE FAMILY SPINAL CARE LLC
Entity type:Organization
Organization Name:ARC OF LIFE FAMILY SPINAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DREW-MONTEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-887-2648
Mailing Address - Street 1:26731 DUBLIN WOODS CIR
Mailing Address - Street 2:STE 2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7271
Mailing Address - Country:US
Mailing Address - Phone:239-200-7248
Mailing Address - Fax:
Practice Address - Street 1:26731 DUBLIN WOODS CIR
Practice Address - Street 2:STE 2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7271
Practice Address - Country:US
Practice Address - Phone:239-200-7248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10720261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service