Provider Demographics
NPI:1992184840
Name:DESERT SPRINGS SCOTTSDALE SOUTH
Entity type:Organization
Organization Name:DESERT SPRINGS SCOTTSDALE SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-406-5310
Mailing Address - Street 1:5529 E BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4203
Mailing Address - Country:US
Mailing Address - Phone:602-546-7553
Mailing Address - Fax:
Practice Address - Street 1:5529 E. BLOOMFIELD RD.
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254
Practice Address - Country:US
Practice Address - Phone:602-546-7553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9482310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968314Medicaid