Healthcare Provider Details

I. General information

NPI: 1578141206
Provider Name (Legal Business Name): STAGECOACH HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47763 MONROE ST
INDIO CA
92201-6711
US

IV. Provider business mailing address

47763 MONROE ST
INDIO CA
92201-6711
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-0750
  • Fax: 760-347-9322
Mailing address:
  • Phone: 760-347-0750
  • Fax: 760-347-9322

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: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249