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General NPI Number Information
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NPI Number | 1417410465
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Entity Type | Organization
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Legal Business Name | HEARTS OF THE DESERT, LLC
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 12914 W CHERRY HILLS DR
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City | EL MIRAGE
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State | AZ
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Zip | 85335-3048
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Country | US
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Telephone | 623-229-5825
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Fax |
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Provider Business Mailing Address
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Address Line | 15778 W CARIBBEAN LN
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City | SURPRISE
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State | AZ
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Zip | 85379-6238
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Country | US
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Telephone | 623-229-5825
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | THANIA PENNINGTON
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Credential | MASTER'S
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Telephone | 623-229-5825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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