Provider Demographics
NPI:1679508774
Name:DESERT REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:DESERT REGIONAL MEDICAL CENTER, INC.
Other - Org Name:DESERT REGIONAL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-6483
Mailing Address - Street 1:PO BOX 57154
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7154
Mailing Address - Country:US
Mailing Address - Phone:760-323-6492
Mailing Address - Fax:760-864-9577
Practice Address - Street 1:555 E. TACHEVAH
Practice Address - Street 2:3E-101
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5749
Practice Address - Country:US
Practice Address - Phone:760-323-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENET HEALTHSYSTEM DESERT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000139315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01520FMedicaid
CAHPC01520FMedicaid