Healthcare Provider Details

I. General information

NPI: 1457217937
Provider Name (Legal Business Name): CANYON FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15087 W ROOSEVELT ST
GOODYEAR AZ
85338-2509
US

IV. Provider business mailing address

5619 N 133RD AVE
LITCHFIELD PARK AZ
85340-8344
US

V. Phone/Fax

Practice location:
  • Phone: 602-435-3810
  • Fax:
Mailing address:
  • Phone: 602-435-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN BROWN-GIBSON
Title or Position: SOLE PROPRIETOR/OWNER
Credential:
Phone: 602-435-3810