Provider Demographics
NPI:1508298803
Name:THE LGBT COMMUNITY CENTER OF THE DESERT
Entity Type:Organization
Organization Name:THE LGBT COMMUNITY CENTER OF THE DESERT
Other - Org Name:THE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-416-7790
Mailing Address - Street 1:611 S PALM CANYON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-7213
Mailing Address - Country:US
Mailing Address - Phone:760-416-7790
Mailing Address - Fax:760-416-7786
Practice Address - Street 1:611 S PALM CANYON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7213
Practice Address - Country:US
Practice Address - Phone:760-416-7790
Practice Address - Fax:760-416-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health