Provider Demographics
NPI:1699289215
Name:DESERT SPRINGS CARE HOME L.L.C.
Entity type:Organization
Organization Name:DESERT SPRINGS CARE HOME L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:RODICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-403-3624
Mailing Address - Street 1:3445 W ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5620
Mailing Address - Country:US
Mailing Address - Phone:602-439-2734
Mailing Address - Fax:602-843-1475
Practice Address - Street 1:3445 W ACOMA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5620
Practice Address - Country:US
Practice Address - Phone:602-439-2734
Practice Address - Fax:602-843-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ010117Medicaid