Provider Demographics
NPI:1164624821
Name:STREAMS IN THE DESERT MINISTRIES, INC.
Entity Type:Organization
Organization Name:STREAMS IN THE DESERT MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-897-1907
Mailing Address - Street 1:5612 S HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2214
Mailing Address - Country:US
Mailing Address - Phone:480-897-1907
Mailing Address - Fax:480-897-1287
Practice Address - Street 1:5612 S HEATHER DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2214
Practice Address - Country:US
Practice Address - Phone:480-897-1907
Practice Address - Fax:480-897-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-1165311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ556871OtherAHCCCS