Healthcare Provider Details

I. General information

NPI: 1801370952
Provider Name (Legal Business Name): GOOD CARE NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 VENTURA DR
BULLHEAD CITY AZ
86442-5824
US

IV. Provider business mailing address

2744 MONA LISA ST
HENDERSON NV
89044-0319
US

V. Phone/Fax

Practice location:
  • Phone: 928-219-4195
  • Fax:
Mailing address:
  • Phone: 313-434-2723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE GIDDINGS
Title or Position: ADMINISTRATOR
Credential:
Phone: 313-434-2723