Provider Demographics
NPI:1598794182
Name:GOOD LIFE MEDICAL SUPPLY CORP
Entity Type:Organization
Organization Name:GOOD LIFE MEDICAL SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-925-8792
Mailing Address - Street 1:1621 S 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6364
Mailing Address - Country:US
Mailing Address - Phone:954-925-8792
Mailing Address - Fax:954-925-8793
Practice Address - Street 1:1621 S 21ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6364
Practice Address - Country:US
Practice Address - Phone:954-925-8792
Practice Address - Fax:954-925-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies