IndividualActive
Dominique Gist
NPI 1629674742 · Psychiatric Residential Treatment Facility · Goodyear, AZ
Provider details
- NPI number
- 1629674742
- Entity type
- Individual
- Primary specialty
- Psychiatric Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Residential Treatment Facilities
Residential Treatment Facilities
- Community/Behavioral Health Agency251S00000X
Agencies
- Substance Abuse Rehabilitation Facility324500000X
Residential Treatment Facilities
Suppliers
Practice location
8674 S 165th Ave
Goodyear, AZ 85338-1447
Phone: (313) 434-6821
Approximate (ZIP-level) locationGet directions
Mailing address
11213 W Ivory Ln
Avondale, AZ 85392-3916
Registry dates
- Enumerated
- 2020-12-05
- Last updated
- 2020-12-05
- Certified
- 2020-12-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.