Provider Demographics
NPI:1730510801
Name:ARC IMPERIAL VALLEY
Entity type:Organization
Organization Name:ARC IMPERIAL VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BA
Authorized Official - Phone:760-352-0180
Mailing Address - Street 1:PO BOX 1828
Mailing Address - Street 2:298 E. ROSS AVE
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-1828
Mailing Address - Country:US
Mailing Address - Phone:760-352-0180
Mailing Address - Fax:760-352-2296
Practice Address - Street 1:298 E ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9303
Practice Address - Country:US
Practice Address - Phone:760-352-0180
Practice Address - Fax:760-352-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA0044428343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)