Provider Demographics
NPI:1427585124
Name:GOODLIFE HOMECARE SERVICES, LLC
Entity Type:Organization
Organization Name:GOODLIFE HOMECARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-626-8038
Mailing Address - Street 1:533 WINDSOR PARK DR
Mailing Address - Street 2:100
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4112
Mailing Address - Country:US
Mailing Address - Phone:937-626-8038
Mailing Address - Fax:877-715-2335
Practice Address - Street 1:533 WINDSOR PARK DR
Practice Address - Street 2:100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4112
Practice Address - Country:US
Practice Address - Phone:937-626-8038
Practice Address - Fax:877-715-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205531Medicaid