MEDICARE: GROVES ASSISTED LIVING PLACE

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	251J00000X	Nursing Care Agency

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	:	1639765381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVES ASSISTED LIVING PLACE

Provider Business Mailing Address
First Line	:	9980 N SHANNON RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8208
Country	:	US
Telephone Number	:	520-396-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3317
Country	:	US
Telephone Number	:	520-881-9032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NORMA Y. CHACON
Credential	:
Telephone Number	:	520-396-0464

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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Directions to “GROVES ASSISTED LIVING PLACE ” Practice Location

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