Healthcare Provider Details

I. General information

NPI: 1790657203
Provider Name (Legal Business Name): TUCSON MOUNTAIN SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N LA CHOLLA BLVD
TUCSON AZ
85741-3502
US

IV. Provider business mailing address

5901 N LA CHOLLA BLVD
TUCSON AZ
85741-3502
US

V. Phone/Fax

Practice location:
  • Phone: 208-207-2726
  • Fax:
Mailing address:
  • Phone: 208-207-2726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AMBER TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726