Provider Demographics
NPI:1508553231
Name:CHOOSE LIFE WELLNESS
Entity Type:Organization
Organization Name:CHOOSE LIFE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-228-7800
Mailing Address - Street 1:PO BOX 50481
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-0481
Mailing Address - Country:US
Mailing Address - Phone:480-228-7800
Mailing Address - Fax:
Practice Address - Street 1:8385 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3440
Practice Address - Country:US
Practice Address - Phone:480-228-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service