Provider Demographics
NPI:1326317413
Name:DESIRE RUSINGIZWA
Entity Type:Organization
Organization Name:DESIRE RUSINGIZWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSINGIZWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-324-3224
Mailing Address - Street 1:12634 W ESTERO LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5156
Mailing Address - Country:US
Mailing Address - Phone:602-214-9544
Mailing Address - Fax:
Practice Address - Street 1:12634 W ESTERO LN
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5156
Practice Address - Country:US
Practice Address - Phone:602-214-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-39183104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-3918Medicaid