MEDICARE: DESERT BLOOM RECOVERY LTD.

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1497458004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT BLOOM RECOVERY LTD.

Provider Business Mailing Address
First Line	:	2520 SAINT ROSE PKWY STE 306
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7790
Country	:	US
Telephone Number	:	801-885-5836
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 SAINT ROSE PKWY STE 306
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7790
Country	:	US
Telephone Number	:	801-885-5836
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENAE LINDSEY
Credential	:	MFT
Telephone Number	:	801-885-5836

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	03/23/2023

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