Healthcare Provider Details

I. General information

NPI: 1548578669
Provider Name (Legal Business Name): PRIMTE TIMER OF THE DESERT FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E TAHQUITZ CANYON WAY SUITE F
PALM SPRINGS CA
92262-6764
US

IV. Provider business mailing address

700 E TAHQUITZ CANYON WAY SUITE F
PALM SPRINGS CA
92262-6764
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-7790
  • Fax: 760-416-7786
Mailing address:
  • Phone: 760-416-7790
  • Fax: 760-416-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HARVEY ELLIOTT STERN
Title or Position: PRESIDENT
Credential:
Phone: 760-416-7790