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General NPI Number Information
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NPI Number | 1174181259
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Entity Type | Organization
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Legal Business Name | GOOD LIFE AT HOME CARE, LLC
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 911 S PARSONS AVE STE C
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City | BRANDON
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State | FL
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Zip | 33511-6042
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Country | US
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Telephone | 813-438-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 409 APOLLO BEACH BLVD
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City | APOLLO BEACH
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State | FL
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Zip | 33572
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Country | US
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Telephone | 813-438-6306
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Fax | 813-502-6322
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL COBB
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Credential |
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Telephone | 541-840-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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