Provider Demographics
NPI:1457932592
Name:GOOD LIFE PRIMARY HOME CARE LLC
Entity Type:Organization
Organization Name:GOOD LIFE PRIMARY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-624-6599
Mailing Address - Street 1:3610 E STEVENSON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1613 PECAN BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4214
Practice Address - Country:US
Practice Address - Phone:956-929-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care