Provider Demographics
NPI:1548755283
Name:IMPERIAL VALLEYRESPITE, INC.
Entity Type:Organization
Organization Name:IMPERIAL VALLEYRESPITE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-351-0825
Mailing Address - Street 1:630 S. IMPERIAL AVE., STE. 2
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227
Mailing Address - Country:US
Mailing Address - Phone:760-351-0825
Mailing Address - Fax:707-561-7746
Practice Address - Street 1:630 S. IMPERIAL AVE., STE. 2
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227
Practice Address - Country:US
Practice Address - Phone:760-351-0825
Practice Address - Fax:707-561-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-26978103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty