Healthcare Provider Details

I. General information

NPI: 1497109599
Provider Name (Legal Business Name): DESERT MISSION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E EVA ST
PHOENIX AZ
85020-2526
US

IV. Provider business mailing address

8125 N HAYDEN RD
SCOTTSDALE AZ
85258-2463
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-6374
  • Fax:
Mailing address:
  • Phone: 480-882-5294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL0159D
License Number StateAZ

VIII. Authorized Official

Name: MS. MICHELLE PABIS
Title or Position: VP GOVERNMENT AND COMMUNITY AFFAIRS
Credential:
Phone: 480-882-5294