Provider Demographics
NPI:1295363232
Name:DESERT RIVER PCA
Entity Type:Organization
Organization Name:DESERT RIVER PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:775-910-2047
Mailing Address - Street 1:1890
Mailing Address - Street 2:S MOUNT CHARLESTON RD W
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048
Mailing Address - Country:US
Mailing Address - Phone:775-910-2047
Mailing Address - Fax:949-577-4501
Practice Address - Street 1:1890
Practice Address - Street 2:S MOUNT CHARLESTON RD W
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:775-910-2047
Practice Address - Fax:949-577-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty