Healthcare Provider Details

I. General information

NPI: 1023817863
Provider Name (Legal Business Name): GOIFUL LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OLD FORTE TRL
SPRING LAKE NC
28390-7427
US

IV. Provider business mailing address

PO BOX 1444
DUNN NC
28335-1444
US

V. Phone/Fax

Practice location:
  • Phone: 919-561-7411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MONTRELLE MCDOUGALD
Title or Position: OWNER/PROVIDER
Credential:
Phone: 919-561-7411