Provider Demographics
NPI:1841745122
Name:JHERNDONS LLC
Entity type:Organization
Organization Name:JHERNDONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-322-1777
Mailing Address - Street 1:559 S PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-7468
Mailing Address - Country:US
Mailing Address - Phone:760-322-1777
Mailing Address - Fax:
Practice Address - Street 1:559 S PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7468
Practice Address - Country:US
Practice Address - Phone:559-901-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION THERAPEUTIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330114AP305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service