Provider Demographics
NPI:1891048641
Name:GOODLIFE RESIDENCE LLC
Entity Type:Organization
Organization Name:GOODLIFE RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-506-5164
Mailing Address - Street 1:PO BOX 331486
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-7514
Mailing Address - Country:US
Mailing Address - Phone:615-506-5164
Mailing Address - Fax:
Practice Address - Street 1:545 MCCRORY CREEK RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3418
Practice Address - Country:US
Practice Address - Phone:615-506-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0522057385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care