Provider Demographics
NPI:1295886067
Name:H.D.P.R.G., INC
Entity type:Organization
Organization Name:H.D.P.R.G., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-367-1743
Mailing Address - Street 1:5930 ADOBE RD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2356
Mailing Address - Country:US
Mailing Address - Phone:760-367-1743
Mailing Address - Fax:760-367-1083
Practice Address - Street 1:5930 ADOBE RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2356
Practice Address - Country:US
Practice Address - Phone:760-367-1743
Practice Address - Fax:760-367-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07515ZOtherBLUE SHIELD
CAGPT000931Medicaid
CA678082OtherACN
CAGCT000411Medicaid
CAZZZ08136ZOtherBLUE SHIELD
CAGPT000930Medicaid
CAGSP000541Medicaid
CAZZZ07514ZOtherBLUE SHIELD
CAZZZ08126ZOtherBLUE SHIELD
CAGCT000410Medicaid
CAZZZ08135ZOtherBLUE SHIELD
CAGSP000540Medicaid
CAZZZ08125ZOtherBLUE SHIELD
CAZZZ08125ZOtherBLUE SHIELD
CAGPT000931Medicaid