Healthcare Provider Details

I. General information

NPI: 1639565088
Provider Name (Legal Business Name): HDMC HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 WHITE FEATHER RD
JOSHUA TREE CA
92252-6605
US

IV. Provider business mailing address

6601 WHITE FEATHER RD
JOSHUA TREE CA
92252-6607
US

V. Phone/Fax

Practice location:
  • Phone: 760-366-1500
  • Fax:
Mailing address:
  • Phone: 760-366-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MIKE KING
Title or Position: CFO
Credential:
Phone: 209-985-3317