Provider Demographics
NPI:1568803963
Name:THE GOOD LIFE FOUNDATION
Entity Type:Organization
Organization Name:THE GOOD LIFE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MRSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-653-4800
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-2475
Mailing Address - Country:US
Mailing Address - Phone:713-653-4800
Mailing Address - Fax:888-495-2634
Practice Address - Street 1:5100 WESTHEIMER RD
Practice Address - Street 2:STE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5596
Practice Address - Country:US
Practice Address - Phone:713-653-4800
Practice Address - Fax:888-495-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320600000XMedicaid
TX343900000XMedicaid
TX320800000XMedicaid
TX343800000Medicaid
TX320900000XMedicaid
TX347C00000XMedicaid
TX322D00000XMedicaid