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General NPI Number Information
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NPI Number | 1407107246
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Entity Type | Organization
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Legal Business Name | GOOD LIFE HOME CARE OF ARIZONA LLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 7373 N SCOTTSDALE RD SUITE 270-B
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-3559
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Country | US
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Telephone | 831-915-6255
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Fax |
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Provider Business Mailing Address
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Address Line | 7373 N SCOTTSDALE RD SUITE 270-B
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-3559
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. MATTHEW BOWERSOX
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Credential |
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Telephone | 831-915-6255
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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 | AZ
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