Provider Demographics
NPI:1316343866
Name:DESERT GRACE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:DESERT GRACE HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GARIBYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-731-8551
Mailing Address - Street 1:4955 S DURANGO DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1054
Mailing Address - Country:US
Mailing Address - Phone:702-889-9003
Mailing Address - Fax:702-889-0644
Practice Address - Street 1:4955 S DURANGO DR STE 117
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1054
Practice Address - Country:US
Practice Address - Phone:702-889-9003
Practice Address - Fax:702-889-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8057HHA0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health