Provider Demographics
NPI:1942282355
Name:GOOD NEIGHBOR ASSISTED LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:GOOD NEIGHBOR ASSISTED LIVING SERVICES, INC.
Other - Org Name:GOOD NEIGHBOR SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-932-4878
Mailing Address - Street 1:16429 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9758
Mailing Address - Country:US
Mailing Address - Phone:623-932-4878
Mailing Address - Fax:623-882-8424
Practice Address - Street 1:16429 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9758
Practice Address - Country:US
Practice Address - Phone:623-932-4878
Practice Address - Fax:623-882-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health