Provider Demographics
NPI:1528593944
Name:GROVES ASSISTED LIVING HOMES, LLC DBA PLUM TREE CARE HOME
Entity Type:Organization
Organization Name:GROVES ASSISTED LIVING HOMES, LLC DBA PLUM TREE CARE HOME
Other - Org Name:PLUM TREE CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-360-8090
Mailing Address - Street 1:7961 W SUNSET RANCH PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8203
Mailing Address - Country:US
Mailing Address - Phone:520-360-8090
Mailing Address - Fax:520-325-9596
Practice Address - Street 1:4014 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3317
Practice Address - Country:US
Practice Address - Phone:520-867-6945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9286H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ884761Medicaid