Healthcare Provider Details

I. General information

NPI: 1306794276
Provider Name (Legal Business Name): ARC-VISTACARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12366 SWEETBOUGH CT
NORTH POTOMAC MD
20878-4746
US

IV. Provider business mailing address

12366 SWEETBOUGH CT
NORTH POTOMAC MD
20878-4746
US

V. Phone/Fax

Practice location:
  • Phone: 207-754-4078
  • Fax:
Mailing address:
  • Phone: 207-754-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. THIERRY IRAMBONA
Title or Position: MANAGER
Credential:
Phone: 207-754-4078