MEDICARE: MRS. JESSICA LORRAINE LUCAS R-MA

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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2501137937	OTHER	AZ	STATE OF ARIZONA DEPARTMENT OF PUBLIC SAFETY- FINGER PRINT CLEARANCE CARD
2	54274	OTHER	AZ	AMERICAN SAFETY & HEALTH INSTITUTE
3	2791281	OTHER	AZ	AMERICAN MEDICAL TECHNOLOGIES

General Provider Information

NPI Number	:	1437658317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LORRAINE LUCAS R-MA

Provider Business Mailing Address
First Line	:	PO BOX 5085
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85385-5085
Country	:	US
Telephone Number	:	602-550-5839
Fax Number	:

Provider Business Practice Location Address
First Line	:	5049 W BEVERLY LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-2029
Country	:	US
Telephone Number	:	602-550-5839
Fax Number	:	602-550-5839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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