Desert Bloom Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

DESERT BLOOM INC.

Doing business as

High Desert Haven

Practice address

1240 College Heights Blvd
Ridgecrest, CA 93555-8066

Phone

(760) 371-1989

Fax

(760) 371-1708

NPI assigned

Mar 4, 2020

Last updated

Mar 4, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Abraham Thengumtharayil Mathew, RCFE ADMINISTRATOR

Title

Ceo/Administrator

Phone

(760) 384-8691

Specialties & licenses 1

Addresses

Other names 1

• High Desert Haven Doing business as

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1467087007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 COLLEGE HEIGHTS BLVD",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935558066",
            "telephone_number": "760-371-1989",
            "fax_number": "760-371-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 COLLEGE HEIGHTS BLVD",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935558066",
            "telephone_number": "760-371-1989",
            "fax_number": "760-371-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT BLOOM INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "MATHEW",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_middle_name": "THENGUMTHARAYIL",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "760-384-8691",
        "authorized_official_credential": "RCFE ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Desert Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard Deamer, M.D.
• Nicole Marie Defelice, MSW
• Eric Delgado
• Tracie Delgado
• Healthy Jayantilal Desai, M.D.
• Desert Oasis Clinic
• Dianne Schindler Aud Inc
• Jacob T. Dines, DO
• Donald J. Dixon, M.D.
• Van Anh Ngoc Doan

• Assisted Living Facility in Ridgecrest, CA
• Providers in Ridgecrest, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.