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General NPI Number Information
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NPI Number | 1487984720
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Entity Type | Organization
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Legal Business Name | DESERT MILAGROS, LLC
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Dates
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Enumeration Date | 01/09/2010
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 3438 N. COUNTRY CLUB ROAD
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City | TUCSON
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State | AZ
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Zip | 85716-1257
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Country | US
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Telephone | 520-531-1040
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Fax | 520-325-1040
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Provider Business Mailing Address
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Address Line | 3438 N. COUNTRY CLUB ROAD
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City | TUCSON
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State | AZ
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Zip | 85716-1257
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Country | US
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Telephone | 520-531-1040
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Fax | 520-325-1040
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FAITH VALENTINA SUASO
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Credential | PH.D.
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Telephone | 520-531-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | BH3142
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | BH3142
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | OTC6580
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License Number State | AZ
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