Provider Demographics
NPI:1881658656
Name:SACRED MOUNTAIN ACUPUNCTURE CL
Entity Type:Organization
Organization Name:SACRED MOUNTAIN ACUPUNCTURE CL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:760-327-3500
Mailing Address - Street 1:611 S. PALM CANYON DRIVE
Mailing Address - Street 2:SUITE 7-574
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-7453
Mailing Address - Country:US
Mailing Address - Phone:760-327-3500
Mailing Address - Fax:760-406-5860
Practice Address - Street 1:2150 EAST TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6817
Practice Address - Country:US
Practice Address - Phone:760-327-3500
Practice Address - Fax:760-406-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty