MEDICARE: GOOD LIFE HOME CARE SERVICES CORPORATION

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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1639588270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LIFE HOME CARE SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	3721 BRIARPARK DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-5255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3721 BRIARPARK DR STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-5255
Country	:	US
Telephone Number	:	956-246-4625
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ODERA CHIDOKA
Credential	:
Telephone Number	:	956-246-4625

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	02/10/2021

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