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General NPI Number Information
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NPI Number | 1679360416
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Entity Type | Organization
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Legal Business Name | DESERT WINDS1, A.L.H. INC.
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 2733 E NORA ST
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City | MESA
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State | AZ
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Zip | 85213-1540
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Country | US
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Telephone | 480-396-5408
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Fax | 480-733-5933
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Provider Business Mailing Address
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Address Line | 2733 E NORA ST
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City | MESA
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State | AZ
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Zip | 85213-1540
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Country | US
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Telephone | 480-396-5408
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Fax | 480-733-5933
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | CONSTANTIN MITRICA
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Credential |
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Telephone | 602-363-7522
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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 |
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License Number State |
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