Provider Demographics
NPI:1720808868
Name:PALM SPRINGS SOBER LIVING
Entity type:Organization
Organization Name:PALM SPRINGS SOBER LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:479-335-5999
Mailing Address - Street 1:PO BOX 2107
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2107
Mailing Address - Country:US
Mailing Address - Phone:413-579-7290
Mailing Address - Fax:
Practice Address - Street 1:1200 PASATIEMPO RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4962
Practice Address - Country:US
Practice Address - Phone:413-579-7290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility