MEDICARE: KEN SEELEY COMMUNITIES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1235646530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEN SEELEY COMMUNITIES

Provider Business Mailing Address
First Line	:	300 S HIGHLAND SPRINGS AVE STE 6C
Second Line	:
City	:	BANNING
State	:	CA
Zip	:	92220-6508
Country	:	US
Telephone Number	:	951-922-5338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 E CALLE FELICIA
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7130
Country	:	US
Telephone Number	:	951-922-5338
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	MR. DARYL RUTHERFORD
Credential	:
Telephone Number	:	951-922-5338

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	03/17/2018

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Directions to “KEN SEELEY COMMUNITIES ” Practice Location

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