Provider Demographics
NPI:1508297896
Name:I.C. WORK TRAINING CENTER
Entity Type:Organization
Organization Name:I.C. WORK TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL DURECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-352-6181
Mailing Address - Street 1:210 WAKE AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9632
Mailing Address - Country:US
Mailing Address - Phone:760-352-6181
Mailing Address - Fax:
Practice Address - Street 1:210 WAKE AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-352-6181
Practice Address - Fax:760-352-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management