Healthcare Provider Details

I. General information

NPI: 1649035528
Provider Name (Legal Business Name): DESERT CARE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 SOUTHERN MAGNOLIA ST
LAS VEGAS NV
89149-1967
US

IV. Provider business mailing address

7225 SOUTHERN MAGNOLIA ST
LAS VEGAS NV
89149-1967
US

V. Phone/Fax

Practice location:
  • Phone: 309-287-6041
  • Fax:
Mailing address:
  • Phone: 309-287-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA COOPER
Title or Position: CO OWNER
Credential:
Phone: 309-287-6041