Provider Demographics
NPI:1851396576
Name:DESERT VALLEY HOSPITAL, LLC
Entity Type:Organization
Organization Name:DESERT VALLEY HOSPITAL, LLC
Other - Org Name:DESERT VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-259-4706
Mailing Address - Street 1:16850 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5794
Mailing Address - Country:US
Mailing Address - Phone:760-241-8000
Mailing Address - Fax:760-951-2034
Practice Address - Street 1:16850 BEAR VALLEY RD
Practice Address - Street 2:ATTENTION HOSPITAL BUSINESS OFFICE
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5794
Practice Address - Country:US
Practice Address - Phone:760-241-8000
Practice Address - Fax:760-951-2034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-17
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000562282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30709FMedicaid
CAHSP40709FMedicaid
CAHSP40709FMedicaid
CAHSP30709FMedicaid