1598758179 NPI number — JEWISH FAMILY SERVICE OF THE DESERT

Table of content: DR. HERBERT MARK CRABTREE M.D. (NPI 1659325785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598758179 NPI number — JEWISH FAMILY SERVICE OF THE DESERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FAMILY SERVICE OF THE DESERT
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:
6
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:
1598758179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 S FARRELL DR
Provider Second Line Business Mailing Address:
SUITE C 208
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-7992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-325-4088
Provider Business Mailing Address Fax Number:
760-778-3781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 S FARRELL DR
Provider Second Line Business Practice Location Address:
SUITE C 208
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-7992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-325-4088
Provider Business Practice Location Address Fax Number:
760-778-3781
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
760-325-4088

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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