MEDICARE: SOL ACOMA ASSISTED LIVING 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	AL10543H	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	:	1548761141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOL ACOMA ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	3437 W ACOMA DRIVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053
Country	:	US
Telephone Number	:	623-313-0827
Fax Number	:	623-201-6004

Provider Business Practice Location Address
First Line	:	3437 W ACOMA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85053-5620
Country	:	US
Telephone Number	:	480-616-2772
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/CO-OWNER
Name	:	MAVU JARICHA
Credential	:
Telephone Number	:	623-313-0827

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	01/02/2019

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