Provider Demographics
NPI:1558354563
Name:GOOD LIFE MEDICAL SYS INC
Entity Type:Organization
Organization Name:GOOD LIFE MEDICAL SYS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-515-3434
Mailing Address - Street 1:1001 W 17TH ST
Mailing Address - Street 2:# R
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4512
Mailing Address - Country:US
Mailing Address - Phone:949-515-3434
Mailing Address - Fax:949-515-3434
Practice Address - Street 1:1001 W 17TH ST
Practice Address - Street 2:SUITE R
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4512
Practice Address - Country:US
Practice Address - Phone:949-515-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03131FMedicaid
4478180001Medicare ID - Type Unspecified