Provider Demographics
NPI:1366837825
Name:HDMC HOLDINGS, LLC
Entity Type:Organization
Organization Name:HDMC HOLDINGS, LLC
Other - Org Name:HI DESERT BEHAVIORAL HEALTH CENTERE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-985-3317
Mailing Address - Street 1:6601 WHITE FEATHER RD
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-6607
Mailing Address - Country:US
Mailing Address - Phone:760-366-7542
Mailing Address - Fax:
Practice Address - Street 1:57407 29 PALMS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2907
Practice Address - Country:US
Practice Address - Phone:760-366-7542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05-0279Medicare PIN