Healthcare Provider Details

I. General information

NPI: 1821899212
Provider Name (Legal Business Name): GOOD LIFE ACTIVITY DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CENTERVIEW DR STE 64
GREENSBORO NC
27407-3708
US

IV. Provider business mailing address

2 CENTERVIEW DR STE 64
GREENSBORO NC
27407-3708
US

V. Phone/Fax

Practice location:
  • Phone: 336-383-8977
  • Fax:
Mailing address:
  • Phone: 336-383-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA BLACKMAN
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 336-383-8977