05D2129517 CLIA NUMBER - ARC-IMPERIAL VALLEY IMPERIAL GROUP HOME

Laboratory Demographics

CLIA Code: 05D2129517
Facility Name: ARC-IMPERIAL VALLEY IMPERIAL GROUP HOME
Facility Address: 709 SOUTH H ST
IMPERIAL, CA
ZIP 92251
Facility Phone: 760 353-9976
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: JORGE F. ROBLES
NPI Number: 1588799670
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D2129517
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	ARC-IMPERIAL VALLEY IMPERIAL GROUP HOME
Street	709 SOUTH H ST
City	IMPERIAL
State	CA
ZIP	92251
Phone	760 353-9976
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/8/2025
Certificate Expiration Date	8/7/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	JORGE F. ROBLES

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This page was last updated on: 9/29/2025