Provider Demographics
NPI:1578655858
Name:DESERT MEDICAL GROUP OF INDIO, INC.
Entity Type:Organization
Organization Name:DESERT MEDICAL GROUP OF INDIO, INC.
Other - Org Name:DESERT OASIS HEALTHCARE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR HOME HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-346-8254
Mailing Address - Street 1:275 N EL CIELO RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6972
Mailing Address - Country:US
Mailing Address - Phone:760-346-8254
Mailing Address - Fax:760-416-4025
Practice Address - Street 1:255 N EL CIELO RD
Practice Address - Street 2:SUITE C308
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6992
Practice Address - Country:US
Practice Address - Phone:760-346-8254
Practice Address - Fax:760-416-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059236Medicare Oscar/Certification