Provider Demographics
NPI:1508493016
Name:GOOD CARE NETWORK LLC
Entity Type:Organization
Organization Name:GOOD CARE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-434-2723
Mailing Address - Street 1:4775 E KRISTEN DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5803
Mailing Address - Country:US
Mailing Address - Phone:313-434-2723
Mailing Address - Fax:
Practice Address - Street 1:4775 E KRISTEN DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5803
Practice Address - Country:US
Practice Address - Phone:313-434-2723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness