Provider Demographics
NPI:1245948173
Name:WHOLE LIFE SENIOR CARE LLC
Entity type:Organization
Organization Name:WHOLE LIFE SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-861-7337
Mailing Address - Street 1:3671 LOTUS DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1350
Mailing Address - Country:US
Mailing Address - Phone:517-861-7337
Mailing Address - Fax:
Practice Address - Street 1:3671 LOTUS DR
Practice Address - Street 2:
Practice Address - City:WATERFORD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48329-1350
Practice Address - Country:US
Practice Address - Phone:517-861-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle