Goodyear Assisted Living Home, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GOODYEAR ASSISTED LIVING HOME, LLC

Practice address

14808 W Amelia Ave
Goodyear, AZ 85395-8205

Phone

(623) 600-8624

NPI assigned

Jan 17, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob Awandem

Title

Owner

Phone

(781) 346-1858

Specialties & licenses 1

Addresses

Other names 1

• Goodyear Assisted Living Home Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1730894569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14808 W AMELIA AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958205",
            "telephone_number": "623-600-8624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14808 W AMELIA AVE",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958205",
            "telephone_number": "623-600-8624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODYEAR ASSISTED LIVING HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-16",
        "status": "A",
        "authorized_official_last_name": "AWANDEM",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-346-1858"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodyear Assisted Living Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.