Provider Demographics
NPI:1639998495
Name:DESERT BLOOM HOME HEALTH INC
Entity type:Organization
Organization Name:DESERT BLOOM HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:LIPARDO
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-996-2508
Mailing Address - Street 1:2785 E DESERT INN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3624
Mailing Address - Country:US
Mailing Address - Phone:909-996-2508
Mailing Address - Fax:
Practice Address - Street 1:2785 E DESERT INN RD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3624
Practice Address - Country:US
Practice Address - Phone:909-996-2508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health