Healthcare Provider Details

I. General information

NPI: 1699726570
Provider Name (Legal Business Name): NH TWENTYNINE PALMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278
US

IV. Provider business mailing address

1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2121
  • Fax: 760-830-2714
Mailing address:
  • Phone: 760-830-2121
  • Fax: 760-830-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SULLIVAN
Title or Position: UBO MANAGER
Credential:
Phone: 760-830-2121