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General NPI Number Information
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NPI Number | 1568128304
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Entity Type | Organization
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Legal Business Name | DESERT MIRAGE HOSPICE, LLC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 11/16/2021
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Provider Practice Location Address
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Address Line | 34400 DATE PALM DR STE F2
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-6837
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Country | US
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Telephone | 760-218-3448
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Fax |
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Provider Business Mailing Address
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Address Line | 12 TUCSON CIR
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City | PALM DESERT
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State | CA
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Zip | 92211-8221
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Country | US
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Telephone | 760-218-3448
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JONATHAN ABEJAR
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Credential | RN
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Telephone | 760-218-3448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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