Provider Demographics
NPI:1588799670
Name:ARC IMPERIAL VALLEY
Entity Type:Organization
Organization Name:ARC IMPERIAL VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CARE & ADVOCACY
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERBER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-353-9976
Mailing Address - Street 1:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-1828
Mailing Address - Country:US
Mailing Address - Phone:760-353-9976
Mailing Address - Fax:
Practice Address - Street 1:298 EAST ROSS 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:760-353-9976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320900000X, 320900000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60069FMedicaid
CALTC60070FMedicaid
CALTC60757FMedicaid