MEDICARE: DEVEREUX ARIZONA

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	385H00000X	Respite Care	BH-721	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	:	1437524972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVEREUX ARIZONA

Provider Business Mailing Address
First Line	:	6141 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-5829
Country	:	US
Telephone Number	:	520-576-5598
Fax Number	:	520-296-8244

Provider Business Practice Location Address
First Line	:	6141 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-5829
Country	:	US
Telephone Number	:	520-576-5598
Fax Number	:	520-296-8244

Authorized Official
Title or Position	:	ADMINISTRATIVE COORDINATOR
Name	:	PAULA LEGGE
Credential	:
Telephone Number	:	520-576-5598

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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Directions to “DEVEREUX ARIZONA ” Practice Location

Language	Start Address	Practice Location

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