Provider Demographics
NPI:1326130188
Name:GOOD PLACE
Entity Type:Organization
Organization Name:GOOD PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-770-5600
Mailing Address - Street 1:14160 DALLAS PKWY
Mailing Address - Street 2:SUITE #300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4319
Mailing Address - Country:US
Mailing Address - Phone:972-770-5600
Mailing Address - Fax:972-770-5666
Practice Address - Street 1:7801 N RICHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6415
Practice Address - Country:US
Practice Address - Phone:817-581-6310
Practice Address - Fax:817-581-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118540310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014420OtherCBA CONTRACT #