Provider Demographics
NPI:1336321165
Name:THE ARC OF SAN DIEGO
Entity Type:Organization
Organization Name:THE ARC OF SAN DIEGO
Other - Org Name:LETICIA GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-685-1175
Mailing Address - Street 1:3030 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3230
Mailing Address - Country:US
Mailing Address - Phone:619-685-1175
Mailing Address - Fax:619-234-3759
Practice Address - Street 1:3030 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3230
Practice Address - Country:US
Practice Address - Phone:619-685-1175
Practice Address - Fax:619-234-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities