MEDICARE: DESERT LIFE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1154285120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT LIFE CENTER LLC

Provider Business Mailing Address
First Line	:	1109 N DYSART RD STE B
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 N DYSART RD STE B
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-1700
Country	:	US
Telephone Number	:	480-915-2288
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MARLO WATKINS
Credential	:
Telephone Number	:	480-915-2288

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “DESERT LIFE CENTER LLC ” Practice Location

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