1215190335 NPI number — DESERT ROSE HEALT CARE SERVICES

Table of content: (NPI 1215190335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215190335 NPI number — DESERT ROSE HEALT CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT ROSE HEALT CARE SERVICES
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:
1215190335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12312 W. DELWOOD DRIVE
Provider Second Line Business Mailing Address:
PO BOX 3699
Provider Business Mailing Address City Name:
ARIZONA CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-483-3439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12312 W. DELWOOD DRIVE
Provider Second Line Business Practice Location Address:
# 3699
Provider Business Practice Location Address City Name:
ARIZONA CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-483-3439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EKANEM
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
520-483-3439

Provider Taxonomy Codes

  • Taxonomy code: 385HR2060X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2419690 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com