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NPI Code Detail

MEDICARE: CATHEDRAL CITY PALMS, LLC

MEDICARE: CATHEDRAL CITY PALMS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation FacilityCA

General Provider Information

NPI Number : 1689921470
Entity Type Code : Organization
Provider Name (Legal Business Name) : CATHEDRAL CITY PALMS, LLC
Provider Business Mailing Address
First Line : 67580 JONES RD
Second Line :
City : CATHEDRAL CITY
State : CA
Zip : 92234-6401
Country : US
Telephone Number : 760-969-4140
Fax Number : 760-969-4179
Provider Business Practice Location Address
First Line : 67580 JONES RD
Second Line :
City : CATHEDRAL CITY
State : CA
Zip : 92234-6401
Country : US
Telephone Number : 760-969-4140
Fax Number : 760-969-4179
Authorized Official
Title or Position : CEO
Name : MRS. JOSIE R HERNDON
Credential :
Telephone Number : 760-969-4147
Provider Enumeration Date : 08/10/2012
Last Update Date : 08/10/2012

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Directions to “CATHEDRAL CITY PALMS, LLC ” Practice Location

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