=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154565836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD FOR LIFE HOME HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2009
-----------------------------------------------------
Last Update Date | 04/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD SUITE 1A5
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-4663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD SUITE 1A5
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-222-4663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANA B CODINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-222-4663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------