MEDICARE: GOOD CARE NETWORK 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1538533617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD CARE NETWORK LLC

Provider Business Mailing Address
First Line	:	22621 N GIBSON DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-8840
Country	:	US
Telephone Number	:	313-434-2723
Fax Number	:

Provider Business Practice Location Address
First Line	:	6313 W FLORENCE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7778
Country	:	US
Telephone Number	:	313-434-2723
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOMINIQUE GIDDINGS
Credential	:
Telephone Number	:	313-434-2723

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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Directions to “GOOD CARE NETWORK LLC ” Practice Location

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