Provider Demographics
NPI:1760813307
Name:BHS LABORATORY SERVICES OF CALIFORNIA LLC
Entity type:Organization
Organization Name:BHS LABORATORY SERVICES OF CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-668-4232
Mailing Address - Street 1:19820 N 7TH STREET
Mailing Address - Street 2:SUITE 204, ATTN FINANCE DEPT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1688
Mailing Address - Country:US
Mailing Address - Phone:928-684-4039
Mailing Address - Fax:623-581-7624
Practice Address - Street 1:67580 JONES RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6401
Practice Address - Country:US
Practice Address - Phone:760-969-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility