Provider Demographics
NPI:1215190335
Name:DESERT ROSE HEALT CARE SERVICES
Entity Type:Organization
Organization Name:DESERT ROSE HEALT CARE SERVICES
Other - Org Name:DESERT ROSE HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-483-3439
Mailing Address - Street 1:12312 W. DELWOOD DRIVE
Mailing Address - Street 2:PO BOX 3699
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85223
Mailing Address - Country:US
Mailing Address - Phone:520-483-3439
Mailing Address - Fax:
Practice Address - Street 1:12312 W. DELWOOD DRIVE
Practice Address - Street 2:# 3699
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85223
Practice Address - Country:US
Practice Address - Phone:520-483-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2419690Medicaid