Healthcare Provider Details

I. General information

NPI: 1417333915
Provider Name (Legal Business Name): DESERT HOT SPRINGS CONGREGATE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66753 HACIENDA AVE
DESERT HOT SPRINGS CA
92240-5863
US

IV. Provider business mailing address

66753 HACIENDA AVE
DESERT HOT SPRINGS CA
92240-5863
US

V. Phone/Fax

Practice location:
  • Phone: 760-898-8412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIKA MNATSAKANYAN
Title or Position: CEO
Credential:
Phone: 760-898-8412