Provider Demographics
NPI:1326349093
Name:WALNUT HOLDINGS, LLC
Entity Type:Organization
Organization Name:WALNUT HOLDINGS, LLC
Other - Org Name:DESERT BLOSSOM HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:60 S 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1507
Mailing Address - Country:US
Mailing Address - Phone:480-832-3903
Mailing Address - Fax:480-981-0963
Practice Address - Street 1:60 S 58TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1507
Practice Address - Country:US
Practice Address - Phone:480-832-3903
Practice Address - Fax:480-981-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ598814Medicaid
AZ035164Medicare Oscar/Certification
035164Medicare Oscar/Certification