Provider Demographics
NPI:1164045803
Name:DESERT HORIZON RESIDENTIAL CARE
Entity type:Organization
Organization Name:DESERT HORIZON RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHATTLES-BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-953-5286
Mailing Address - Street 1:15952 CONDOR RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394
Mailing Address - Country:US
Mailing Address - Phone:760-953-5286
Mailing Address - Fax:
Practice Address - Street 1:15952 CONDOR RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394
Practice Address - Country:US
Practice Address - Phone:760-953-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility