Provider Demographics
NPI:1770125403
Name:DESERT GEM ASSISTED LIVING FACILITY, LLC
Entity type:Organization
Organization Name:DESERT GEM ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIOSCORO
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:TAGLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-208-5137
Mailing Address - Street 1:1734 E. BAHREND DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1205
Mailing Address - Country:US
Mailing Address - Phone:480-208-5137
Mailing Address - Fax:480-369-5748
Practice Address - Street 1:3236 W. EUGIE AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:480-639-3290
Practice Address - Fax:480-639-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home