1528359544 NPI number — DESERT HAVEN ADULT CARE HOME LLC

Table of content: (NPI 1528359544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528359544 NPI number — DESERT HAVEN ADULT CARE HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT HAVEN ADULT CARE HOME LLC
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:
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:
1528359544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8925 E 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85710-3041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-306-6931
Provider Business Mailing Address Fax Number:
520-885-4976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9681 E BRIANA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85748-7405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-306-6931
Provider Business Practice Location Address Fax Number:
520-885-4976
Provider Enumeration Date:
04/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REINARD
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
520-306-6931

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  AL8124H , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311ZA0620X , with the licence number: AL8238H , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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