Provider Demographics
NPI:1619220399
Name:CHARTER HOSPICE OF THE DESERT LLC
Entity Type:Organization
Organization Name:CHARTER HOSPICE OF THE DESERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-316-4539
Mailing Address - Street 1:72855 FRED WARING DR
Mailing Address - Street 2:SUITE A5
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72855 FRED WARING DR
Practice Address - Street 2:SUITE A5
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9368
Practice Address - Country:US
Practice Address - Phone:909-825-2969
Practice Address - Fax:909-825-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based