MEDICARE: DESERT HAVEN HOME CARE 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1376149070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT HAVEN HOME CARE LLC

Provider Business Mailing Address
First Line	:	4123 N 21ST ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6109
Country	:	US
Telephone Number	:	602-670-9326
Fax Number	:	602-393-9097

Provider Business Practice Location Address
First Line	:	4123 N 21ST ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-6109
Country	:	US
Telephone Number	:	602-670-9326
Fax Number	:	602-393-9097

Authorized Official
Title or Position	:	CEO
Name	:	DR. CHRISTOPHER D. ZAMBAKARI
Credential	:	BS, MBA, MIS, LP.D.
Telephone Number	:	602-670-9326

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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Directions to “DESERT HAVEN HOME CARE LLC ” Practice Location

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