Provider Demographics
NPI:1053955070
Name:DESERT WIND HOSPICE, INC.
Entity type:Organization
Organization Name:DESERT WIND HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGANGEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-255-4311
Mailing Address - Street 1:14359 AMARGOSA RD STE O
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2385
Mailing Address - Country:US
Mailing Address - Phone:442-255-4311
Mailing Address - Fax:
Practice Address - Street 1:14359 AMARGOSA RD STE O
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2385
Practice Address - Country:US
Practice Address - Phone:442-255-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based