Healthcare Provider Details

I. General information

NPI: 1467167445
Provider Name (Legal Business Name): GOOD CARE & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 OLD HIGHWAY 441 S STE 220
MOUNT DORA FL
32757-7039
US

IV. Provider business mailing address

3065 DANIELS RD # 1321
WINTER GARDEN FL
34787-7002
US

V. Phone/Fax

Practice location:
  • Phone: 689-208-4848
  • Fax: 689-219-3746
Mailing address:
  • Phone: 689-208-4848
  • Fax: 689-219-3746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAXIME DEBROSSE
Title or Position: PAIN PHYSICIAN
Credential: MD
Phone: 689-208-4848