Provider Demographics
NPI:1225476344
Name:LANDMARK AT DESERT GARDENS
Entity Type:Organization
Organization Name:LANDMARK AT DESERT GARDENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIOVANNUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:7818497722
Authorized Official - Phone:781-849-7722
Mailing Address - Street 1:200 S LINAM ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6040
Mailing Address - Country:US
Mailing Address - Phone:575-408-7883
Mailing Address - Fax:575-393-4578
Practice Address - Street 1:200 S LINAM ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6040
Practice Address - Country:US
Practice Address - Phone:575-408-7883
Practice Address - Fax:575-393-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility