Provider Demographics
NPI:1558944389
Name:DESERT BREEZE OF MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:DESERT BREEZE OF MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDENFEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-492-2008
Mailing Address - Street 1:2734 S BAR DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0059
Mailing Address - Country:US
Mailing Address - Phone:209-623-7508
Mailing Address - Fax:
Practice Address - Street 1:4823 E APACHE CIR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2102
Practice Address - Country:US
Practice Address - Phone:480-492-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA