MEDICARE: STATE OF ARIZONA/STATE DEPT OF FINANCE

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	314000000X	Skilled Nursing Facility	NCI-212	AZ
2	314000000X	Skilled Nursing Facility	NCI212	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	:	1336444181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF ARIZONA/STATE DEPT OF FINANCE

Provider Business Mailing Address
First Line	:	555 E AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6104
Country	:	US
Telephone Number	:	520-638-2150
Fax Number	:	520-638-2166

Provider Business Practice Location Address
First Line	:	555 EAST AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713
Country	:	US
Telephone Number	:	520-638-2150
Fax Number	:	520-638-2166

Authorized Official
Title or Position	:	REGIONAL BUSINESS OFFICE MANAGER
Name	:	BRIDGETT TUCKER
Credential	:
Telephone Number	:	623-824-2458

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	05/26/2026

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Directions to “STATE OF ARIZONA/STATE DEPT OF FINANCE ” Practice Location

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