Healthcare Provider Details

I. General information

NPI: 1942282355
Provider Name (Legal Business Name): GOOD NEIGHBOR ASSISTED LIVING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16429 W MAGNOLIA ST
GOODYEAR AZ
85338-9758
US

IV. Provider business mailing address

16429 W MAGNOLIA ST
GOODYEAR AZ
85338-9758
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-4878
  • Fax: 623-882-8424
Mailing address:
  • Phone: 623-932-4878
  • Fax: 623-882-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. HARRY DE LEON
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 623-932-4878