MEDICARE: MM&J HEALTHCARE SERVICES 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	AL8740	AZ

General Provider Information

NPI Number	:	1831602697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MM&J HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	4581 N AVENIDA DEL CAZADOR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6803
Country	:	US
Telephone Number	:	840-938-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3161 S PROSPEROUS PL
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-6403
Country	:	US
Telephone Number	:	480-938-2000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARK FALAGRADY
Credential	:
Telephone Number	:	480-938-2000

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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