Provider Demographics
NPI:1598235640
Name:A LIFE CHOICE FOR PERSONAL ENHANCEMENT, LLC
Entity Type:Organization
Organization Name:A LIFE CHOICE FOR PERSONAL ENHANCEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL-FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-362-0504
Mailing Address - Street 1:401 WHITNEY AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2577
Mailing Address - Country:US
Mailing Address - Phone:504-994-9193
Mailing Address - Fax:504-463-4086
Practice Address - Street 1:401 WHITNEY AVE STE 135
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2577
Practice Address - Country:US
Practice Address - Phone:504-994-9193
Practice Address - Fax:504-463-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency