Provider Demographics
NPI:1477873990
Name:INDIO HEALTHCARE & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:INDIO HEALTHCARE & WELLNESS CENTER, LLC
Other - Org Name:DESERT SPRINGS HEALTHCARE & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-855-5492
Mailing Address - Street 1:82262 VALENCIA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3120
Mailing Address - Country:US
Mailing Address - Phone:760-347-6000
Mailing Address - Fax:760-775-6403
Practice Address - Street 1:82262 VALENCIA AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3120
Practice Address - Country:US
Practice Address - Phone:760-347-6000
Practice Address - Fax:760-775-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000156314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05278JMedicaid
CAZZT05278JMedicaid