Provider Demographics
NPI:1326199662
Name:DESERT PALMS
Entity Type:Organization
Organization Name:DESERT PALMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-985-0680
Mailing Address - Street 1:152 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8718
Mailing Address - Country:US
Mailing Address - Phone:480-985-0680
Mailing Address - Fax:480-396-6231
Practice Address - Street 1:152 N 56TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8718
Practice Address - Country:US
Practice Address - Phone:480-985-0680
Practice Address - Fax:480-396-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-4917310400000X
AZ311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL351982-01Medicaid
AL805244Medicaid