1184366676 NPI number — GOOD VIBES FAMILY CARE COMPANY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184366676 NPI number — GOOD VIBES FAMILY CARE COMPANY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD VIBES FAMILY CARE COMPANY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184366676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 W FREISTADT RD UNIT 371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THIENSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53092-4018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-305-9254
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11220 W BURLEIGH ST # M101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-305-9254
Provider Business Practice Location Address Fax Number:
262-786-7758
Provider Enumeration Date:
04/13/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOKS
Authorized Official First Name:
JOCLYN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/ CARE DIRECTOR
Authorized Official Telephone Number:
262-894-9554

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)