Provider Demographics
NPI:1871031401
Name:GOOD LIVING CAREGIVERS AGENCY, LLC
Entity Type:Organization
Organization Name:GOOD LIVING CAREGIVERS AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:SITOU
Authorized Official - Last Name:AGBAKPEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-478-3329
Mailing Address - Street 1:4535 MAIN ST
Mailing Address - Street 2:112
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1815
Mailing Address - Country:US
Mailing Address - Phone:314-478-3329
Mailing Address - Fax:
Practice Address - Street 1:4535 MAIN ST
Practice Address - Street 2:112
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1815
Practice Address - Country:US
Practice Address - Phone:314-478-3329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care