Provider Demographics
NPI:1447701750
Name:GOOD LIFE CORPORATION
Entity type:Organization
Organization Name:GOOD LIFE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIF
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-740-4688
Mailing Address - Street 1:178 EARLY ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:VA
Mailing Address - Zip Code:22844-9600
Mailing Address - Country:US
Mailing Address - Phone:540-740-4688
Mailing Address - Fax:540-740-8808
Practice Address - Street 1:178 EARLY ST
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:VA
Practice Address - Zip Code:22844-9600
Practice Address - Country:US
Practice Address - Phone:540-740-4688
Practice Address - Fax:540-740-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2377-01-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities