Healthcare Provider Details

I. General information

NPI: 1184767121
Provider Name (Legal Business Name): GOOD LIFE RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18653 VENTURA BLVD SUITE 139
TARZANA CA
91356-4103
US

IV. Provider business mailing address

18653 VENTURA BLVD SUITE 139
TARZANA CA
91356-4103
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-3344
  • Fax: 818-705-5533
Mailing address:
  • Phone: 818-906-3344
  • Fax: 818-705-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROL KLINGER
Title or Position: MANAGER
Credential:
Phone: 818-906-3344