Provider Demographics
NPI:1568128304
Name:DESERT MIRAGE HOSPICE, LLC
Entity Type:Organization
Organization Name:DESERT MIRAGE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEJAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-218-3448
Mailing Address - Street 1:12 TUCSON CIR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8221
Mailing Address - Country:US
Mailing Address - Phone:760-218-3448
Mailing Address - Fax:
Practice Address - Street 1:34400 DATE PALM DR STE F2
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6837
Practice Address - Country:US
Practice Address - Phone:760-218-3448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based