Provider Demographics
NPI:1417220989
Name:CHARTER HIGH DESERT HEALTH CARE GROUP, LLC
Entity Type:Organization
Organization Name:CHARTER HIGH DESERT HEALTH CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-825-2969
Mailing Address - Street 1:19015 TOWN CENTER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8943
Mailing Address - Country:US
Mailing Address - Phone:760-247-1161
Mailing Address - Fax:
Practice Address - Street 1:19015 TOWN CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-8943
Practice Address - Country:US
Practice Address - Phone:760-247-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based