Healthcare Provider Details

I. General information

NPI: 1912403718
Provider Name (Legal Business Name): DESERT CANYON POST ACUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

400 EXCHANGE STE 140
IRVINE CA
92602-1343
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-8463
  • 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: JOSE LYNCH
Title or Position: MANAGING MEMBER
Credential:
Phone: 714-673-6810