Provider Demographics
NPI:1093701856
Name:DESERT HEALTH CARE FACILITIES, INC
Entity Type:Organization
Organization Name:DESERT HEALTH CARE FACILITIES, INC
Other - Org Name:FALLON HEALTH CARE, LLC - HIGHLAND MANOR OF FALLON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-343-1550
Mailing Address - Street 1:550 N SHERMAN
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406
Mailing Address - Country:US
Mailing Address - Phone:775-423-7800
Mailing Address - Fax:775-423-7845
Practice Address - Street 1:550 N SHERMAN
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406
Practice Address - Country:US
Practice Address - Phone:775-423-7800
Practice Address - Fax:775-423-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4202SNF8314000000X
NV4202SNF-8314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506408Medicaid
NV295085Medicare Oscar/Certification