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NPI Code Detail

MEDICARE: GOOD PLACE

MEDICARE: GOOD PLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility118540TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001014420OTHERTXCBA CONTRACT #

General Provider Information

NPI Number : 1326130188
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOOD PLACE
Provider Business Mailing Address
First Line : 14160 DALLAS PKWY
Second Line : SUITE #300
City : DALLAS
State : TX
Zip : 75254-4319
Country : US
Telephone Number : 972-770-5600
Fax Number : 972-770-5666
Provider Business Practice Location Address
First Line : 7801 N RICHLAND BLVD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-6415
Country : US
Telephone Number : 817-581-6310
Fax Number : 817-581-0608
Authorized Official
Title or Position : PRESIDENT & COO
Name : MR. KEITH JOHANNESSEN
Credential :
Telephone Number : 972-770-5600
Provider Enumeration Date : 09/29/2006
Last Update Date : 06/18/2008

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Directions to “GOOD PLACE ” Practice Location

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