Provider Demographics
NPI:1144788514
Name:LIFECHOICES LLC
Entity Type:Organization
Organization Name:LIFECHOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:OLUSHOLA
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-328-4819
Mailing Address - Street 1:417 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2752
Mailing Address - Country:US
Mailing Address - Phone:612-328-4819
Mailing Address - Fax:
Practice Address - Street 1:417 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2752
Practice Address - Country:US
Practice Address - Phone:612-328-4819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM928-209-3295OtherTELEPHONE