Provider Demographics
NPI:1104597053
Name:DESERT HEARTS NURSING AND HOME CARE, LLC
Entity type:Organization
Organization Name:DESERT HEARTS NURSING AND HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-804-6083
Mailing Address - Street 1:5225 S HIGHWAY 95 STE 10
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9111
Mailing Address - Country:US
Mailing Address - Phone:928-577-2688
Mailing Address - Fax:928-577-2689
Practice Address - Street 1:5225 S HIGHWAY 95 STE 10
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9111
Practice Address - Country:US
Practice Address - Phone:928-577-2688
Practice Address - Fax:928-577-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care