Provider Demographics
NPI:1972879096
Name:GOOD LIFE HEALING CENTER LLC
Entity Type:Organization
Organization Name:GOOD LIFE HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-301-8485
Mailing Address - Street 1:7401 50TH TER E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7903
Mailing Address - Country:US
Mailing Address - Phone:941-567-6465
Mailing Address - Fax:
Practice Address - Street 1:5325 LENA RD STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9442
Practice Address - Country:US
Practice Address - Phone:941-301-8485
Practice Address - Fax:941-799-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty