Provider Demographics
NPI:1487984720
Name:DESERT MILAGROS, LLC
Entity type:Organization
Organization Name:DESERT MILAGROS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:VALENTINA
Authorized Official - Last Name:SUASO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-531-1040
Mailing Address - Street 1:3438 N. COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1257
Mailing Address - Country:US
Mailing Address - Phone:520-531-1040
Mailing Address - Fax:520-325-1040
Practice Address - Street 1:3438 N. COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1257
Practice Address - Country:US
Practice Address - Phone:520-531-1040
Practice Address - Fax:520-325-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3142261QM0850X, 261QM0855X
AZOTC6580261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health