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General NPI Number Information
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NPI Number | 1295413425
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Entity Type | Organization
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Legal Business Name | MJDE LLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 25548 WHITE OAK DR
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City | HEMET
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State | CA
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Zip | 92544-5366
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Country | US
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Telephone | 760-468-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 23327 SARATOGA SPRINGS PL
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City | MURRIETA
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State | CA
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Zip | 92562-4803
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Country | US
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Telephone | 760-468-3444
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. SHEY WALDROP
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Credential | CADCLL
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Telephone | 760-468-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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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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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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