=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366837114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&F HEALTHCARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2015
-----------------------------------------------------
Last Update Date | 03/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4110 E ANDERSON ST
-----------------------------------------------------
City | SIERRA VISTA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85650-9414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-785-6095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4598 E TREMAINE CT
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85234-7667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-785-6095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / MANAGER
-----------------------------------------------------
Name | MR. MARK FALAGRADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-785-6095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9636C
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------