Provider Demographics
NPI:1720606882
Name:MOUNTAIN DESERT HEALTH LLC
Entity Type:Organization
Organization Name:MOUNTAIN DESERT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:505-553-0003
Mailing Address - Street 1:2200 PANOLA ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2582
Mailing Address - Country:US
Mailing Address - Phone:505-553-0003
Mailing Address - Fax:
Practice Address - Street 1:2200 PANOLA ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2582
Practice Address - Country:US
Practice Address - Phone:505-553-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty