Provider Demographics
NPI:1215178199
Name:LIFECHOICES TREATMENT SERVICES, INC
Entity Type:Organization
Organization Name:LIFECHOICES TREATMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LICKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-799-7372
Mailing Address - Street 1:1157 E TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1658
Mailing Address - Country:US
Mailing Address - Phone:408-971-7811
Mailing Address - Fax:408-998-4337
Practice Address - Street 1:1157 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1658
Practice Address - Country:US
Practice Address - Phone:408-971-7811
Practice Address - Fax:408-998-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430049AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility