MEDICARE: PALM SPRINGS REHAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1154016558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM SPRINGS REHAB LLC

Provider Business Mailing Address
First Line	:	68487 E PALM CANYON DR STE 44
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-5434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	68487 E PALM CANYON DR STE 44
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-5434
Country	:	US
Telephone Number	:	310-343-8684
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NATHAN YOUNG
Credential	:
Telephone Number	:	310-343-8684

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	06/20/2023

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Directions to “PALM SPRINGS REHAB LLC ” Practice Location

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