Healthcare Provider Details

I. General information

NPI: 1629405220
Provider Name (Legal Business Name): PALM SPRINGS VILLA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68580 TORTUGA RD
CATHEDRAL CITY CA
92234-3875
US

IV. Provider business mailing address

68580 TORTUGA RD
CATHEDRAL CITY CA
92234-3875
US

V. Phone/Fax

Practice location:
  • Phone: 760-515-7779
  • Fax: 760-841-0982
Mailing address:
  • Phone: 760-515-7779
  • Fax: 760-841-0982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LEVON AKHSHARUMOV
Title or Position: CEO
Credential:
Phone: 760-515-7779