Provider Demographics
NPI:1487791083
Name:DESERT FAMILY HEALTH CARE LLC
Entity type:Organization
Organization Name:DESERT FAMILY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS FNP
Authorized Official - Phone:928-451-6559
Mailing Address - Street 1:765 W AZURE DR
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-4945
Mailing Address - Country:US
Mailing Address - Phone:928-451-6559
Mailing Address - Fax:
Practice Address - Street 1:765 W AZURE DR
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-4945
Practice Address - Country:US
Practice Address - Phone:928-451-6559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 114868 AP 2200261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP2200OtherAP LICENSE #
F0805137OtherCERTIFICATION NUMBER AANP
AZRN 114868OtherRN LICENSE #
AZRN 114868OtherRN LICENSE #