Healthcare Provider Details

I. General information

NPI: 1003972241
Provider Name (Legal Business Name): DESERT ROCK COMMUNITY CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 S HARL AVE STE 6
TEMPE AZ
85283-4367
US

IV. Provider business mailing address

7307 S HARL AVE STE 6
TEMPE AZ
85283-4367
US

V. Phone/Fax

Practice location:
  • Phone: 480-752-7992
  • Fax: 480-422-4450
Mailing address:
  • Phone: 480-752-7992
  • Fax: 480-422-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES A. LAINE
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 480-752-7992