Provider Demographics
NPI:1033864889
Name:GORMANS ASSISTED LIVING
Entity Type:Organization
Organization Name:GORMANS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-304-2123
Mailing Address - Street 1:2250 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2715
Mailing Address - Country:US
Mailing Address - Phone:520-304-2123
Mailing Address - Fax:520-867-6188
Practice Address - Street 1:2250 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2715
Practice Address - Country:US
Practice Address - Phone:520-304-2123
Practice Address - Fax:520-867-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility