Organization
GOOD CARE NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE GIDDINGS (ADMINISTRATOR/OWNER)
(313) 434-2723
Entity
Organization
Contact information
Practice address
13250 W PORT ROYALE LN, SURPRISE, AZ 85379-6520
(928) 299-2952
Mailing address
378 N SHORE LN, GILBERT, AZ 85233-4702
(313) 434-2723
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
AZ
Enumeration date
03/30/2018
Last updated
06/16/2018
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