Provider Demographics
NPI:1689921470
Name:CATHEDRAL CITY PALMS, LLC
Entity Type:Organization
Organization Name:CATHEDRAL CITY PALMS, LLC
Other - Org Name:DESERT PALMS RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-969-4147
Mailing Address - Street 1:67580 JONES RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-6401
Mailing Address - Country:US
Mailing Address - Phone:760-969-4140
Mailing Address - Fax:760-969-4179
Practice Address - Street 1:67580 JONES RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6401
Practice Address - Country:US
Practice Address - Phone:760-969-4140
Practice Address - Fax:760-969-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility