Provider Demographics
NPI:1528359544
Name:DESERT HAVEN ADULT CARE HOME LLC
Entity Type:Organization
Organization Name:DESERT HAVEN ADULT CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:REINARD
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MANAGER
Authorized Official - Phone:520-306-6931
Mailing Address - Street 1:8925 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3041
Mailing Address - Country:US
Mailing Address - Phone:520-306-6931
Mailing Address - Fax:520-885-4976
Practice Address - Street 1:9681 E BRIANA LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-7405
Practice Address - Country:US
Practice Address - Phone:520-306-6931
Practice Address - Fax:520-885-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8124H311ZA0620X
AZAL8238H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home