Provider Demographics
NPI:1437862398
Name:GOOD MEDICENE HOMES LLC
Entity Type:Organization
Organization Name:GOOD MEDICENE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-301-7883
Mailing Address - Street 1:301 W AJO WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6040
Mailing Address - Country:US
Mailing Address - Phone:520-301-7883
Mailing Address - Fax:
Practice Address - Street 1:9221 E DOLORES ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2132
Practice Address - Country:US
Practice Address - Phone:520-301-7883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child