=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669895041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESERT COMMUNITY HOSPICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2014
-----------------------------------------------------
Last Update Date | 02/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13849 AMARGOSA RD STE 206
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92392-2474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-538-3080
-----------------------------------------------------
Fax | 760-538-3085
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13849 AMARGOSA RD STE 206
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92392-2474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-538-3080
-----------------------------------------------------
Fax | 760-538-3085
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ANAHID SAFARIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-538-3080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------