NPIMap

Organization Active NPI

Desert Life Center LLC

  • Community/Behavioral Health Agency
  • Avondale, AZ
National Provider Identifier
1962107607
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
DESERT LIFE CENTER LLC
Practice address
1109 N Dysart Rd Ste B
Avondale, AZ 85323-1700
Phone
(415) 424-0419
NPI assigned
Apr 3, 2023
Last updated
Oct 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Authorized official

Name
Sandra Patricia Balinda-Kamanyire
Title
Member
Phone
(415) 424-0419

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1109 N Dysart Rd Ste B
Avondale, AZ 85323-1700

Mailing address

1109 N Dysart Rd Ste B
Avondale, AZ 85323-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240104000765 AZ Part B Supplier - Clinic/Group Practice 1850742818 Receives reassigned benefits from 1 practitioner
Practice locations: Avondale, AZ

National Provider Directory

National Provider Directory
Tax ID family
Desert Life Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1962107607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 N DYSART RD STE B",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853231700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 N DYSART RD STE B",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853231700",
            "telephone_number": "415-424-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT LIFE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-03",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "BALINDA-KAMANYIRE",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "415-424-0419"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.