Organization
HEARTH STONE HOUSE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK L. SMITH M.D. (M.D./MEDICAL DIRECTOR)
(760) 779-1999
Entity
Organization
Contact information
Practice address
44500 SAN PASQUAL AVE, PALM DESERT, CA 92260-3650
(760) 779-1999
Mailing address
PO BOX 1642, WILDOMAR, CA 92595-1642
(760) 779-1999
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
330134AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330134AP
DCHS 330134AP
CA
Enumeration date
10/01/2015
Last updated
10/01/2015
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