1013114776 NPI number — DUAL DIAGNOSIS MANAGEMENT, LLC DBA PALMSPRINGS SERENITY RETREAT

Table of content: (NPI 1013114776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013114776 NPI number — DUAL DIAGNOSIS MANAGEMENT, LLC DBA PALMSPRINGS SERENITY RETREAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUAL DIAGNOSIS MANAGEMENT, LLC DBA PALMSPRINGS SERENITY RETREAT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013114776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 WESTWOOD PL
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-587-7771
Provider Business Mailing Address Fax Number:
954-587-8622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2095 N INDIAN CANYON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-587-7771
Provider Business Practice Location Address Fax Number:
954-587-8622
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARTWRIGHT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
615-345-3200

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  330014CP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com