Healthcare Provider Details

I. General information

NPI: 1275201022
Provider Name (Legal Business Name): SCOTT WARD CADC CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 E GEM CIR
PALM SPRINGS CA
92262-2354
US

IV. Provider business mailing address

1473 E GEM CIR
PALM SPRINGS CA
92262-2354
US

V. Phone/Fax

Practice location:
  • Phone: 760-464-2611
  • Fax:
Mailing address:
  • Phone: 760-464-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberTBD
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberTBD
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: