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General NPI Number Information
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NPI Number | 1447381835
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Entity Type | Organization
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Legal Business Name | GOODLIFE INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7429 INTERNATIONAL DR
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City | HOLLAND
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State | OH
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Zip | 43528-8623
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Country | US
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Telephone | 419-866-7700
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Fax | 419-866-1695
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Provider Business Mailing Address
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Address Line | 7429 INTERNATIONAL DR
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City | HOLLAND
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State | OH
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Zip | 43528-8623
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Country | US
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Telephone | 419-866-7700
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Fax | 419-866-1695
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Authorized Official
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Title or Position | PRESIDENT, MEDICAL DIRECTOR
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Name | DR. PATRICK JOHN CORP
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Credential | M.D.
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Telephone | 419-866-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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