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NPI Code Detail

MEDICARE: CHARTER HIGH DESERT HEALTH CARE GROUP, LLC

MEDICARE: CHARTER HIGH DESERT HEALTH CARE GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251G00000XCommunity Based Hospice Care Agency

General Provider Information

NPI Number : 1417220989
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARTER HIGH DESERT HEALTH CARE GROUP, LLC
Provider Business Mailing Address
First Line : 19015 TOWN CENTER DR
Second Line : SUITE 104
City : APPLE VALLEY
State : CA
Zip : 92308-8943
Country : US
Telephone Number : 760-247-1161
Fax Number :
Provider Business Practice Location Address
First Line : 19015 TOWN CENTER DR
Second Line : SUITE 104
City : APPLE VALLEY
State : CA
Zip : 92308-8943
Country : US
Telephone Number : 760-247-1161
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : FRED B FRANK
Credential :
Telephone Number : 909-825-2969
Provider Enumeration Date : 02/14/2012
Last Update Date : 02/14/2012

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Directions to “CHARTER HIGH DESERT HEALTH CARE GROUP, LLC ” Practice Location

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