Healthcare Provider Details

I. General information

NPI: 1881097335
Provider Name (Legal Business Name): HIGH DESERT ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 BOEING DR STE 12
EL PASO TX
79925-1256
US

IV. Provider business mailing address

8630 BOEING DR STE 12
EL PASO TX
79925-1256
US

V. Phone/Fax

Practice location:
  • Phone: 915-779-2200
  • Fax: 915-779-2229
Mailing address:
  • Phone: 915-779-2200
  • Fax: 915-779-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC D GREEN
Title or Position: OWNER
Credential:
Phone: 915-779-2200