Provider Demographics
NPI:1992256143
Name:DESERT INN RESIDENTIAL CARE
Entity type:Organization
Organization Name:DESERT INN RESIDENTIAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-203-3450
Mailing Address - Street 1:7160 DARBY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3122
Mailing Address - Country:US
Mailing Address - Phone:702-203-3450
Mailing Address - Fax:702-252-5092
Practice Address - Street 1:2845 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1793
Practice Address - Country:US
Practice Address - Phone:702-203-3450
Practice Address - Fax:702-252-5092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT INN RESIDENTIAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3119AGZ-13311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home