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General NPI Number Information
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NPI Number | 1568803963
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Entity Type | Organization
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Legal Business Name | THE GOOD LIFE FOUNDATION
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Dates
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Enumeration Date | 07/13/2013
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Last Update Date | 07/13/2013
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Provider Practice Location Address
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Address Line | 5100 WESTHEIMER RD STE 200
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City | HOUSTON
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State | TX
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Zip | 77056-5596
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Country | US
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Telephone | 713-653-4800
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Fax | 888-495-2634
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Provider Business Mailing Address
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Address Line | PO BOX 2475
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City | BELLAIRE
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State | TX
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Zip | 77402-2475
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Country | US
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Telephone | 713-653-4800
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Fax | 888-495-2634
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHALONDA MRSHALL
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Credential |
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Telephone | 713-653-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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