Organization
GRACE HOME ASSISTED LIVING 1
Active
Other names
Grace Home Assisted Living 2
Organization subpart
No
Provider details
NPI number
Authorized official
NORMA BRAGA (OWNER)
(520) 312-0225
Entity
Organization
Contact information
Practice address
2301 S QUAIL HOLLOW DR, TUCSON, AZ 85710-7986
(520) 312-0225
(520) 207-2223
Mailing address
2261 S QUAIL HOLLOW DR, TUCSON, AZ 85710-7982
(520) 312-0225
(520) 207-2223
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
AL6571H
AZ
320700000X
Physical Disabilities Residential Treatment Facility
Primary
AL6571H
AZ
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AL6571-H
AZ
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AL7454H
AZ
3747A0650X
Attendant Care Provider
AL7454-H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00416712603
TRICARE PRIME INSURANCE
AZ
01
—
0301305850
AARP
AZ
01
—
783517401
MEDICAID AND AARP
—
01
—
85808889
MEDICAID AND MUTUAL OF OMAHA
AZ
01
—
95188554F13239
MEDICAID
CA
Enumeration date
04/19/2017
Last updated
04/19/2017
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