Provider Demographics
NPI:1679050850
Name:GOOD LIFE MEDICAL SYSTEMS
Entity type:Organization
Organization Name:GOOD LIFE MEDICAL SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-274-4983
Mailing Address - Street 1:2991 GRACE LN STE 1E
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4110
Mailing Address - Country:US
Mailing Address - Phone:949-274-4983
Mailing Address - Fax:714-557-5500
Practice Address - Street 1:2991 GRACE LN STE 1E
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4110
Practice Address - Country:US
Practice Address - Phone:949-274-4983
Practice Address - Fax:714-557-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies