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General NPI Number Information
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NPI Number | 1740856251
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Entity Type | Organization
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Legal Business Name | GOOD LIFE HOME HEALTH
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 1264 S WATERMAN AVE STE 27
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2848
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Country | US
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Telephone | 909-332-7792
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Fax | 909-494-7593
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Provider Business Mailing Address
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Address Line | 1264 S WATERMAN AVE STE 27
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2848
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Country | US
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Telephone | 909-332-7792
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Fax | 909-494-7593
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Authorized Official
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Title or Position | CEO
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Name | LATESHA KING
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Credential |
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Telephone | 909-332-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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