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General NPI Number Information
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NPI Number | 1891048641
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Entity Type | Organization
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Legal Business Name | GOODLIFE RESIDENCE LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 545 MCCRORY CREEK RD
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City | NASHVILLE
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State | TN
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Zip | 37214-3418
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Country | US
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Telephone | 615-506-5164
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331486
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City | NASHVILLE
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State | TN
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Zip | 37203-7514
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Country | US
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Telephone | 615-506-5164
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. SHAWANDA D CLAY
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Credential | NP
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Telephone | 615-506-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 0522057
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License Number State | TN
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