Provider Demographics
NPI:1184366676
Name:GOOD VIBES FAMILY CARE COMPANY, LLC
Entity type:Organization
Organization Name:GOOD VIBES FAMILY CARE COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-894-9554
Mailing Address - Street 1:124 W FREISTADT RD UNIT 371
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-4018
Mailing Address - Country:US
Mailing Address - Phone:262-305-9254
Mailing Address - Fax:
Practice Address - Street 1:11220 W BURLEIGH ST # M101
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-3213
Practice Address - Country:US
Practice Address - Phone:262-305-9254
Practice Address - Fax:262-786-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility