MEDICARE: GROVES ASSISTED LIVING HOMES, LLC DBA PLUM TREE CARE HOME

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	AL9286H	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528593944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVES ASSISTED LIVING HOMES, LLC DBA PLUM TREE CARE HOME

Provider Business Mailing Address
First Line	:	7961 W SUNSET RANCH PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-8203
Country	:	US
Telephone Number	:	520-360-8090
Fax Number	:	520-325-9596

Provider Business Practice Location Address
First Line	:	4014 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3317
Country	:	US
Telephone Number	:	520-867-6945
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. SHERRE M WEEKS
Credential	:	R.N.
Telephone Number	:	520-360-8090

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	04/24/2017

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