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NPISignal

Individual Healthcare Provider

Dominique L Gist

NPI Record: ActivePsychiatric Residential Treatment Facility
NPI1629674742
Goodyear, Arizona

Provider's NPPES record last updated: December 5, 2020

Overview

Entity Type
Individual Healthcare Provider
NPI
1629674742
Primary Specialty
Psychiatric Residential Treatment Facility
Practice Location
Goodyear, Arizona
Sole Proprietor
Yes

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 21, 2026, 8:35 AM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Psychiatric Residential Treatment Facility

    Residential Treatment Facilities

    Primary

    A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary

    Taxonomy code 323P00000X
  • Community Based Residential Treatment Facility, Mental Illness

    Residential Treatment Facilities

    A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

    Taxonomy code 320800000X
  • Community/Behavioral Health

    Agencies

    A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

    Taxonomy code 251S00000X
  • Substance Abuse Rehabilitation Facility

    Residential Treatment Facilities

    A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

    Taxonomy code 324500000X
  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

    Suppliers

    An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

    Taxonomy code 332800000X

Practice Locations

Practice Location

8674 S 165th Ave

Goodyear, Arizona 85338-1447

Phone: (313) 434-6821

Record Information

Enumeration Date
December 5, 2020
Provider's NPPES Record Last Updated
December 5, 2020
Certification Date
December 5, 2020
NPISignal NPPES Dataset
August 2026

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