Provider Demographics
NPI:1033543988
Name:DESERT VISIONS YOUTH WELLNESS CENTER
Entity type:Organization
Organization Name:DESERT VISIONS YOUTH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-431-4096
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:198 S. SKILL CENTER ROAD
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147
Mailing Address - Country:US
Mailing Address - Phone:888-431-4096
Mailing Address - Fax:520-562-3415
Practice Address - Street 1:198 S. SKILL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147
Practice Address - Country:US
Practice Address - Phone:888-431-4096
Practice Address - Fax:520-562-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0157171324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility