Provider Demographics
NPI:1467087007
Name:DESERT BLOOM INC.
Entity Type:Organization
Organization Name:DESERT BLOOM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:THENGUMTHARAYIL
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RCFE ADMINISTRATOR
Authorized Official - Phone:760-384-8691
Mailing Address - Street 1:1240 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-8066
Mailing Address - Country:US
Mailing Address - Phone:760-371-1989
Mailing Address - Fax:760-371-1708
Practice Address - Street 1:1240 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-8066
Practice Address - Country:US
Practice Address - Phone:760-371-1989
Practice Address - Fax:760-371-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility