Provider Demographics
NPI:1447381835
Name:GOODLIFE INC
Entity Type:Organization
Organization Name:GOODLIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CORP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-866-7700
Mailing Address - Street 1:7429 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8623
Mailing Address - Country:US
Mailing Address - Phone:419-866-7700
Mailing Address - Fax:419-866-1695
Practice Address - Street 1:7429 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8623
Practice Address - Country:US
Practice Address - Phone:419-866-7700
Practice Address - Fax:419-866-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0813301Medicaid
OH0681233Medicare ID - Type Unspecified
OH0813301Medicaid