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General NPI Number Information
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NPI Number | 1235646530
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Entity Type | Organization
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Legal Business Name | KEN SEELEY COMMUNITIES
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1990 E CALLE FELICIA
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7130
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Country | US
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Telephone | 951-922-5338
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Fax |
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Provider Business Mailing Address
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Address Line | 300 S HIGHLAND SPRINGS AVE STE 6C
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City | BANNING
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State | CA
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Zip | 92220-6508
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Country | US
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Telephone | 951-922-5338
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. DARYL RUTHERFORD
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Credential |
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Telephone | 951-922-5338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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