MEDICARE: EAST TUCSON CARE HOMES, LLC

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

General Provider Information

NPI Number	:	1508335639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST TUCSON CARE HOMES, LLC

Provider Business Mailing Address
First Line	:	5252 E ALHAMBRA PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1306
Country	:	US
Telephone Number	:	520-891-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	7622 E CALLE CABO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-2721
Country	:	US
Telephone Number	:	520-505-4378
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANGELIQUE A ROY
Credential	:
Telephone Number	:	520-891-5756

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	11/19/2018

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