Provider Demographics
NPI:1336642768
Name:CAMELIA DRAGOMIR AND ANDREI IONUT DANILA DBA GOODYEAR ASSISTED LIVING
Entity Type:Organization
Organization Name:CAMELIA DRAGOMIR AND ANDREI IONUT DANILA DBA GOODYEAR ASSISTED LIVING
Other - Org Name:CAMELIA DRAGOMIR AND ANDREI IONUT DANILA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMELIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRAGOMIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-225-7990
Mailing Address - Street 1:14808 W AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8205
Mailing Address - Country:US
Mailing Address - Phone:623-225-7990
Mailing Address - Fax:623-225-7996
Practice Address - Street 1:14808 W AMELIA AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8205
Practice Address - Country:US
Practice Address - Phone:623-225-7990
Practice Address - Fax:623-225-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10587H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility