Organization
DESERT SAGE HEALING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA A HOLD (MANAGING MEMBER)
(480) 356-4370
Entity
Organization
Contact information
Practice address
18256 E WILLIAMS FIELD RD STE 6, GILBERT, AZ 85295-6808
(480) 356-4370
Mailing address
20211 E VIA DEL ORO, QUEEN CREEK, AZ 85142-6270
(480) 356-4370
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091693
—
AZ
Enumeration date
11/26/2020
Last updated
05/03/2021
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