Healthcare Provider Details

I. General information

NPI: 1972205276
Provider Name (Legal Business Name): PCD SENIOR 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N PALM CANYON DR
PALM SPRINGS CA
92262-2832
US

IV. Provider business mailing address

2150 N PALM CANYON DR
PALM SPRINGS CA
92262-2832
US

V. Phone/Fax

Practice location:
  • Phone: 760-548-0970
  • Fax:
Mailing address:
  • Phone: 760-548-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA LEVY
Title or Position: OWNER
Credential:
Phone: 213-503-2261