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General NPI Number Information
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NPI Number | 1295363232
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Entity Type | Organization
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Legal Business Name | DESERT RIVER PCA
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 1890 S MOUNT CHARLESTON RD W
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City | PAHRUMP
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State | NV
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Zip | 89048
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Country | US
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Telephone | 775-910-2047
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Fax | 949-577-4501
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Provider Business Mailing Address
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Address Line | 1890 S MOUNT CHARLESTON RD W
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City | PAHRUMP
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State | NV
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Zip | 89048
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Country | US
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Telephone | 775-910-2047
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Fax | 949-577-4501
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Authorized Official
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Title or Position | MANAGER
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Name | RONALDO LLOYD
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Credential | EMT
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Telephone | 775-910-2047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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