MEDICARE: JAMISON SENIOR LIVING COMMUNITIES, 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	311500000X	Alzheimer Center (Dementia Center)	AL7186C	AZ

General Provider Information

NPI Number	:	1659771103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMISON SENIOR LIVING COMMUNITIES, LLC

Provider Business Mailing Address
First Line	:	1020 N WOODLAND AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-7308
Country	:	US
Telephone Number	:	520-777-3198
Fax Number	:	520-777-4723

Provider Business Practice Location Address
First Line	:	1020 N WOODLAND AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-7308
Country	:	US
Telephone Number	:	520-777-3198
Fax Number	:	520-777-4723

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. KENDALL JAMISON
Credential	:
Telephone Number	:	520-777-3198

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	09/02/2014

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