Healthcare Provider Details

I. General information

NPI: 1396281630
Provider Name (Legal Business Name): DESERT COVE AT DESERT HOT SPRINGS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 MOUNTAIN VIEW RD
DESERT HOT SPRINGS CA
92240-6454
US

IV. Provider business mailing address

13660 MOUNTAIN VIEW RD
DESERT HOT SPRINGS CA
92240-6454
US

V. Phone/Fax

Practice location:
  • Phone: 760-671-7820
  • Fax: 760-671-7713
Mailing address:
  • Phone: 760-671-7820
  • Fax: 760-671-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number336426550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number336426550
License Number StateCA

VIII. Authorized Official

Name: ERIKA L HEYWOOD
Title or Position: SENIOR EXECUTIVE DIRECTOR
Credential: LVN
Phone: 760-671-7820