NPIMap

Organization Active NPI

Peacock Desert Rose Services Limited

  • Licensed Vocational Nurse
  • San Bernardino, CA
National Provider Identifier
1356945562
Registry record updated Nov 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
Legal business name
PEACOCK DESERT ROSE SERVICES LIMITED
Practice address
967 Kendall Dr # A329
San Bernardino, CA 92407-4306
Phone
(909) 689-6095
NPI assigned
Nov 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kai HarperNPI 1568066785
Title
President
Phone
(909) 689-6095

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164X00000X Primary
Case Management Agency 251B00000X
Nursing Care Agency 251J00000X
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

967 Kendall Dr # A329
San Bernardino, CA 92407-4306

Mailing address

967 Kendall Dr # A329
San Bernardino, CA 92407-4306
Phone (909) 689-6095

National Provider Directory

National Provider Directory

Locations

967 Kendall Dr
#A329
San Bernardino, CA 92407
Phone (909) 689-6095

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606608000000",
    "number": "1356945562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 KENDALL DR # A329",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924074306",
            "telephone_number": "909-689-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "967 KENDALL DR # A329",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924074306",
            "telephone_number": "909-689-6095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACOCK DESERT ROSE SERVICES LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-29",
        "last_updated": "2020-11-29",
        "certification_date": "2020-11-21",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "KAI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-689-6095"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Vocational Nurse",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.