Provider Demographics
NPI:1346078151
Name:GOOD LIFE HEALTHCARE LLC
Entity type:Organization
Organization Name:GOOD LIFE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-828-8109
Mailing Address - Street 1:450 MAPLE AVE E STE 303E
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4743
Mailing Address - Country:US
Mailing Address - Phone:301-828-8109
Mailing Address - Fax:
Practice Address - Street 1:450 MAPLE AVE E STE 303E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4743
Practice Address - Country:US
Practice Address - Phone:301-828-8109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care