Provider Demographics
NPI:1316172968
Name:DESERT MOUNTAIN LLC
Entity type:Organization
Organization Name:DESERT MOUNTAIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:KLAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-618-5572
Mailing Address - Street 1:5959 GATEWAY BLVD W STE 403
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3318
Mailing Address - Country:US
Mailing Address - Phone:915-843-1119
Mailing Address - Fax:
Practice Address - Street 1:5959 GATEWAY BLVD W STE 403
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3318
Practice Address - Country:US
Practice Address - Phone:915-843-1119
Practice Address - Fax:866-546-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010033253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care