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General NPI Number Information
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NPI Number | 1528359544
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Entity Type | Organization
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Legal Business Name | DESERT HAVEN ADULT CARE HOME LLC
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 9681 E BRIANA LN
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City | TUCSON
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State | AZ
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Zip | 85748-7405
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Country | US
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Telephone | 520-306-6931
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Fax | 520-885-4976
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Provider Business Mailing Address
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Address Line | 8925 E 5TH ST
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City | TUCSON
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State | AZ
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Zip | 85710-3041
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Country | US
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Telephone | 520-306-6931
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Fax | 520-885-4976
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. HOLLY CATHERINE REINARD
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Credential | LICENSED MANAGER
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Telephone | 520-306-6931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AL8238H
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AL8124H
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License Number State | AZ
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