MEDICARE: JEWISH FAMILY SERVICE OF THE DESERT

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598758179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICE OF THE DESERT

Provider Business Mailing Address
First Line	:	490 S FARRELL DR
Second Line	:	SUITE C 208
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7992
Country	:	US
Telephone Number	:	760-325-4088
Fax Number	:	760-778-3781

Provider Business Practice Location Address
First Line	:	490 S FARRELL DR
Second Line	:	SUITE C 208
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7992
Country	:	US
Telephone Number	:	760-325-4088
Fax Number	:	760-778-3781

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KRAIG JOHNSON
Credential	:
Telephone Number	:	760-325-4088

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	08/11/2020

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