Healthcare Provider Details

I. General information

NPI: 1407641459
Provider Name (Legal Business Name): DESERT RAIN PERSONAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 DONA AVE
GRANTS NM
87020-2312
US

IV. Provider business mailing address

1308 DONA AVE
GRANTS NM
87020-2312
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-8502
  • Fax:
Mailing address:
  • Phone: 505-285-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WARREN CHAVEZ
Title or Position: CCO
Credential:
Phone: 505-285-8502