Provider Demographics
NPI:1336883834
Name:PALM SPRINGS SOBER LIVING
Entity Type:Organization
Organization Name:PALM SPRINGS SOBER LIVING
Other - Org Name:PALO VERDE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-973-5427
Mailing Address - Street 1:707 E TAHQUITZ CANYON WAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6773
Mailing Address - Country:US
Mailing Address - Phone:760-464-5673
Mailing Address - Fax:
Practice Address - Street 1:707 E TAHQUITZ CANYON WAY STE 14
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6773
Practice Address - Country:US
Practice Address - Phone:760-464-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility