Healthcare Provider Details

I. General information

NPI: 1376482521
Provider Name (Legal Business Name): 417 SOUTH RIVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45902 OASIS ST STE B
INDIO CA
92201-4580
US

IV. Provider business mailing address

74075 EL PASEO STE A5
PALM DESERT CA
92260-4118
US

V. Phone/Fax

Practice location:
  • Phone: 844-417-3417
  • Fax: 442-282-1100
Mailing address:
  • Phone: 844-417-3417
  • Fax: 442-282-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEVIE KUHN
Title or Position: OWNER
Credential:
Phone: 760-485-6563