MEDICARE: SAM HUGHES ASSISTED LIVING

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	AL9048H	AZ

General Provider Information

NPI Number	:	1366871535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAM HUGHES ASSISTED LIVING

Provider Business Mailing Address
First Line	:	2914 E 4TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-4424
Country	:	US
Telephone Number	:	520-529-2797
Fax Number	:	520-881-9465

Provider Business Practice Location Address
First Line	:	2914 E 4TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-4424
Country	:	US
Telephone Number	:	520-529-2797
Fax Number	:	520-881-9465

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH ELLIS KOKROKO
Credential	:
Telephone Number	:	520-529-2797

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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