MEDICARE: TUCSON BG OPCO 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	:	1538616719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON BG OPCO LLC

Provider Business Mailing Address
First Line	:	330 N WABASH AVE
Second Line	:	SUITE 3700
City	:	CHICAGO
State	:	IL
Zip	:	60611-3586
Country	:	US
Telephone Number	:	312-725-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 N SWAN RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6968
Country	:	US
Telephone Number	:	520-299-7755
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	PETER TARSNEY
Credential	:
Telephone Number	:	312-725-7000

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	11/16/2016

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