Provider Demographics
NPI:1760430896
Name:GOODLIFE PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:GOODLIFE PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:AFOLAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-436-2484
Mailing Address - Street 1:1480 NW 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4568
Mailing Address - Country:US
Mailing Address - Phone:954-436-2484
Mailing Address - Fax:954-436-2092
Practice Address - Street 1:1480 NW 94TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-4568
Practice Address - Country:US
Practice Address - Phone:954-436-2484
Practice Address - Fax:954-436-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management