Provider Demographics
NPI:1679148803
Name:DESERT CAREGIVER AGENCY
Entity Type:Organization
Organization Name:DESERT CAREGIVER AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-834-1212
Mailing Address - Street 1:75101 SEGO LN STE J1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5194
Mailing Address - Country:US
Mailing Address - Phone:760-346-4840
Mailing Address - Fax:
Practice Address - Street 1:75101 SEGO LN STE J1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5194
Practice Address - Country:US
Practice Address - Phone:760-346-4840
Practice Address - Fax:760-636-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care