Healthcare Provider Details

I. General information

NPI: 1487791083
Provider Name (Legal Business Name): DESERT FAMILY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 W AZURE DR
CAMP VERDE AZ
86322-4945
US

IV. Provider business mailing address

765 W AZURE DR
CAMP VERDE AZ
86322-4945
US

V. Phone/Fax

Practice location:
  • Phone: 928-451-6559
  • Fax:
Mailing address:
  • Phone: 928-451-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberRN 114868 AP 2200
License Number StateAZ

VIII. Authorized Official

Name: MRS. LAURA D HANSON
Title or Position: MANAGING MEMBER
Credential: M.S. F.N.P.
Phone: 928-451-6559