Provider Demographics
NPI:1851960165
Name:DESERT REGIONAL HOSPICE INC
Entity Type:Organization
Organization Name:DESERT REGIONAL HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARCK ANTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-829-8903
Mailing Address - Street 1:35325 DATE PALM DR STE 245B
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7015
Mailing Address - Country:US
Mailing Address - Phone:818-371-5979
Mailing Address - Fax:
Practice Address - Street 1:35325 DATE PALM DR STE 245B
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7015
Practice Address - Country:US
Practice Address - Phone:818-371-5979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based