Healthcare Provider Details

I. General information

NPI: 1003561317
Provider Name (Legal Business Name): DESERT SERENITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68896 CORRAL RD
CATHEDRAL CITY CA
92234-4214
US

IV. Provider business mailing address

68896 CORRAL RD
CATHEDRAL CITY CA
92234-4214
US

V. Phone/Fax

Practice location:
  • Phone: 760-397-7034
  • Fax: 760-377-9003
Mailing address:
  • Phone: 760-397-7034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SPEDALIERE
Title or Position: OWNER
Credential:
Phone: 760-397-7034