MEDICARE: GOOD LIFE HOME HEALTH CARE SERVICES, INC.

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		CA

General Provider Information

NPI Number	:	1790786150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LIFE HOME HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	2501 COLORADO BLVD
Second Line	:	UNIT G
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1055
Country	:	US
Telephone Number	:	323-478-9471
Fax Number	:	323-478-9475

Provider Business Practice Location Address
First Line	:	2501 COLORADO BLVD
Second Line	:	UNIT G
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1055
Country	:	US
Telephone Number	:	323-478-9471
Fax Number	:	323-478-9475

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JEMIMA MARTINEZ-CRUZ
Credential	:	RN
Telephone Number	:	323-478-9471

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/26/2007

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