Provider Demographics
NPI:1790466191
Name:DESERT HAVEN HOSPICE LLC
Entity Type:Organization
Organization Name:DESERT HAVEN HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-641-3016
Mailing Address - Street 1:7150 E CAMELBACK RD STE 442
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1257
Mailing Address - Country:US
Mailing Address - Phone:480-805-5821
Mailing Address - Fax:480-805-5156
Practice Address - Street 1:7150 E CAMELBACK RD STE 442
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1257
Practice Address - Country:US
Practice Address - Phone:480-805-5821
Practice Address - Fax:480-805-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based