Healthcare Provider Details

I. General information

NPI: 1053936427
Provider Name (Legal Business Name): GOODLIFE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RYANT BLVD
SEBRING FL
33870-8075
US

IV. Provider business mailing address

13 RYANT BLVD
SEBRING FL
33870-8075
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-4445
  • Fax: 863-382-4447
Mailing address:
  • Phone: 863-382-4445
  • Fax: 863-382-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID KEATLEY WALDRON
Title or Position: MANAGING MEMBER
Credential:
Phone: 863-382-4445