MEDICARE: HOPE SPRINGS MEMORY CARE, 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)

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	:	1871060004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE SPRINGS MEMORY CARE, LLC

Provider Business Mailing Address
First Line	:	5425 E BROADWAY BLVD STE 353
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3704
Country	:	US
Telephone Number	:	520-392-8575
Fax Number	:	520-844-6922

Provider Business Practice Location Address
First Line	:	4762 E ADAMS ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4002
Country	:	US
Telephone Number	:	520-392-8575
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANICE KUHANECK
Credential	:
Telephone Number	:	520-392-8575

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	10/25/2018

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