MEDICARE: LIFE CARE AT HOME OF TUCSON, INC

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	251E00000X	Home Health Agency	HHA 3307	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0702780	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	779051	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1942203005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE AT HOME OF TUCSON, INC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5256
Fax Number	:	423-339-8356

Provider Business Practice Location Address
First Line	:	1820 E RIVER RD
Second Line	:	SUITE D 100
City	:	TUCSON
State	:	AZ
Zip	:	85718-5888
Country	:	US
Telephone Number	:	520-498-2288
Fax Number	:	520-498-4693

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MS. PAMELA RAU
Credential	:
Telephone Number	:	423-473-5280

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/22/2008

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