Provider Demographics
NPI:1336356674
Name:DESERT BEHAVIORAL SPECIALTIES, LLC
Entity Type:Organization
Organization Name:DESERT BEHAVIORAL SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, CATC
Authorized Official - Phone:760-353-9994
Mailing Address - Street 1:1073 WEST ROSS AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-353-9994
Mailing Address - Fax:760-353-9995
Practice Address - Street 1:1073 ROSS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4371
Practice Address - Country:US
Practice Address - Phone:760-353-9994
Practice Address - Fax:760-353-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder