Provider Demographics
NPI:1417918574
Name:LIFES CHOICES INC
Entity Type:Organization
Organization Name:LIFES CHOICES INC
Other - Org Name:LIFES DOORS HCS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:RN PHD
Authorized Official - Phone:208-947-0967
Mailing Address - Street 1:420 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1238
Mailing Address - Country:US
Mailing Address - Phone:208-947-0967
Mailing Address - Fax:208-947-0967
Practice Address - Street 1:420 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1238
Practice Address - Country:US
Practice Address - Phone:208-947-0967
Practice Address - Fax:208-947-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1931LS3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1307544OtherNCPDP PROVIDER IDENTIFICATION NUMBER
ID807140400Medicaid