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General NPI Number Information
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NPI Number | 1770125403
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Entity Type | Organization
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Legal Business Name | DESERT GEM ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 3236 W. EUGIE AVENUE
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City | PHOENIX
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State | AZ
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Zip | 85029
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Country | US
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Telephone | 480-639-3290
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Fax | 480-639-5748
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Provider Business Mailing Address
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Address Line | 1734 E. BAHREND DRIVE
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City | PHOENIX
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State | AZ
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Zip | 85024-1205
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Country | US
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Telephone | 480-208-5137
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Fax | 480-369-5748
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. DIOSCORO ANGELO TAGLE JR.
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Credential |
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Telephone | 480-208-5137
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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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