MEDICARE: MOHAMED AID

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
2	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1457114647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED AID

Provider Business Mailing Address
First Line	:	6840 E 12TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 S 122ND AVE
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-8419
Country	:	US
Telephone Number	:	520-528-8062
Fax Number	:

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

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/02/2024

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Directions to “ MOHAMED AID ” Practice Location

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