MEDICARE: GOOD LIFE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1417888066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LIFE HOME CARE LLC

Provider Business Mailing Address
First Line	:	55 S STATE AVE STE 353
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3890
Country	:	US
Telephone Number	:	317-643-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE STE 353
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3890
Country	:	US
Telephone Number	:	317-643-2153
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAQUANTA S SHAW
Credential	:
Telephone Number	:	317-627-8590

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “GOOD LIFE HOME CARE LLC ” Practice Location

Language	Start Address	Practice Location

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