Healthcare Provider Details

I. General information

NPI: 1609947845
Provider Name (Legal Business Name): GOOD NEIGHBOR ASSISTED LIVING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 W ROOSEVELT PKWY SUITE 213
GOODYEAR AZ
85338-9282
US

IV. Provider business mailing address

15655 W ROOSEVELT PKWY SUITE 213
GOODYEAR AZ
85338-9282
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-4878
  • Fax: 623-850-9985
Mailing address:
  • Phone: 623-932-4878
  • Fax: 623-850-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. ARTHUR P. DE MARAH
Title or Position: CFO
Credential: CPA
Phone: 623-932-4878