| Desert Life Center Llc | |
|
1109 N Dysart Rd Ste B Avondale AZ 85323-1700 | |
| (415) 424-0419 | |
| Not Available |
| Full Name | Desert Life Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1109 N Dysart Rd Ste B, Avondale, Arizona |
| Authorized Official Name and Position | Sandra Patricia Balinda-kamanyire (MEMBER) |
| Authorized Official Contact | 4154240419 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Life Center Llc 1109 N Dysart Rd Ste B Avondale AZ 85323-1700 Ph: () - | Desert Life Center Llc 1109 N Dysart Rd Ste B Avondale AZ 85323-1700 Ph: (415) 424-0419 |
| NPI Number | 1962107607 |
|---|---|
| Provider Enumeration Date | 04/03/2023 |
| Last Update Date | 10/16/2025 |
| Certification Date | 10/16/2025 |
| Medicare PECOS PAC ID | 1850742818 |
|---|---|
| Medicare Enrollment ID | O20240104000765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962107607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Vincent Bett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740902766 PECOS PAC ID: 7517312226 Enrollment ID: I20240104000984 |
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