Provider Demographics
NPI:1811498272
Name:DESERT RIDGE FACILITY GROUP, LLC
Entity type:Organization
Organization Name:DESERT RIDGE FACILITY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-714-8185
Mailing Address - Street 1:3724 N 3RD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2035
Mailing Address - Country:US
Mailing Address - Phone:602-714-8185
Mailing Address - Fax:602-714-8117
Practice Address - Street 1:7629 E PINNACLE PEAK RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6291
Practice Address - Country:US
Practice Address - Phone:602-714-8185
Practice Address - Fax:602-714-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical