Provider Demographics
NPI:1316285950
Name:ADDICTION MEDICAL SERVICES
Entity type:Organization
Organization Name:ADDICTION MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DATSON
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:206-852-8815
Mailing Address - Street 1:1250 OAKHURST CT
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-9705
Mailing Address - Country:US
Mailing Address - Phone:206-852-8815
Mailing Address - Fax:760-406-6077
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY STE 46
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6784
Practice Address - Country:US
Practice Address - Phone:206-852-8815
Practice Address - Fax:760-406-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16694261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty