MEDICARE: PAPY MCGUIRE ASSISTED LIVING HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL9941L	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AL9941H	OTHER	AZ	AL9941H

General Provider Information

NPI Number	:	1063871945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAPY MCGUIRE ASSISTED LIVING HOME LLC

Provider Business Mailing Address
First Line	:	202 W FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705
Country	:	US
Telephone Number	:	520-887-5402
Fax Number	:	520-887-0182

Provider Business Practice Location Address
First Line	:	202 W FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-3814
Country	:	US
Telephone Number	:	520-887-5402
Fax Number	:	520-887-0182

Authorized Official
Title or Position	:	MEMBER/OWNER
Name	:	MS. YOLANDA APODACA
Credential	:
Telephone Number	:	520-887-5402

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	02/19/2016

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