Organization
BANNER DESERT MEDICAL CENTER
Active
Other names
Banner Desert Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
2145 W SOUTHERN AVE, MESA, AZ 85202-4715
(480) 890-4800
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
538712
—
AZ
Enumeration date
01/23/2007
Last updated
01/13/2022
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