Provider Demographics
NPI:1972956621
Name:JHERNDONS LLC
Entity Type:Organization
Organization Name:JHERNDONS LLC
Other - Org Name:ADDICTION THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-283-0495
Mailing Address - Street 1:64223 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1143
Mailing Address - Country:US
Mailing Address - Phone:760-774-1362
Mailing Address - Fax:
Practice Address - Street 1:69730 HIGHWAY 111 STE 109
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2873
Practice Address - Country:US
Practice Address - Phone:760-835-1631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JHERNDONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-18
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330114AP305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization