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General NPI Number Information
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NPI Number | 1801452180
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Entity Type | Organization
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Legal Business Name | GOOD LIFE PALLIATIVE CARE
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 20953 DEVONSHIRE ST STE 8A
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City | CHATSWORTH
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State | CA
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Zip | 91311-2371
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Country | US
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Telephone | 310-877-8067
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Fax |
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Provider Business Mailing Address
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Address Line | 20953 DEVONSHIRE ST STE 8A
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City | CHATSWORTH
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State | CA
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Zip | 91311-2371
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Country | US
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Telephone | 310-877-8067
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. HOLLIS FREDERICK
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Credential |
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Telephone | 310-877-8067
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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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