Provider Demographics
NPI:1386321354
Name:GREATER GOOD HEALTH PC INC
Entity type:Organization
Organization Name:GREATER GOOD HEALTH PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-795-8807
Mailing Address - Street 1:300 CONTINENTAL BLVD STE 635
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5040
Mailing Address - Country:US
Mailing Address - Phone:310-658-3775
Mailing Address - Fax:
Practice Address - Street 1:405 3RD ST NW STE 102&103
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-4111
Practice Address - Country:US
Practice Address - Phone:310-658-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care