Healthcare Provider Details

I. General information

NPI: 1891096087
Provider Name (Legal Business Name): GOODLIFE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VETERANS MEMORIAL HWY SE SUITE 134 #305
MABLETON GA
30126-2945
US

IV. Provider business mailing address

1400 VETERANS MEMORIAL HWY SE SUITE 134 #305
MABLETON GA
30126-2945
US

V. Phone/Fax

Practice location:
  • Phone: 888-689-7657
  • Fax: 866-672-9398
Mailing address:
  • Phone: 888-689-7657
  • Fax: 866-672-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL ANTHONY WRIGHT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 770-783-1415