Provider Demographics
NPI:1831496421
Name:HIGH DESERT CENTER
Entity Type:Organization
Organization Name:HIGH DESERT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-217-5517
Mailing Address - Street 1:16248 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3934
Mailing Address - Country:US
Mailing Address - Phone:760-243-7151
Mailing Address - Fax:
Practice Address - Street 1:16248 VICTOR ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3934
Practice Address - Country:US
Practice Address - Phone:760-243-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360030AN251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable