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General NPI Number Information
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NPI Number | 1790786150
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Entity Type | Organization
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Legal Business Name | GOOD LIFE HOME HEALTH CARE SERVICES, INC.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 2501 COLORADO BLVD UNIT G
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City | LOS ANGELES
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State | CA
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Zip | 90041-1055
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Country | US
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Telephone | 323-478-9471
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Fax | 323-478-9475
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Provider Business Mailing Address
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Address Line | 2501 COLORADO BLVD UNIT G
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City | LOS ANGELES
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State | CA
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Zip | 90041-1055
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Country | US
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Telephone | 323-478-9471
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Fax | 323-478-9475
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEMIMA MARTINEZ-CRUZ
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Credential | RN
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Telephone | 323-478-9471
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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 | CA
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