Provider Demographics
NPI:1821864562
Name:LIFE CHOICES LLC
Entity Type:Organization
Organization Name:LIFE CHOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELVENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILYOFAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:757-685-8585
Mailing Address - Street 1:116 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6310
Mailing Address - Country:US
Mailing Address - Phone:757-685-8585
Mailing Address - Fax:
Practice Address - Street 1:1545 CROSSWAYS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0218
Practice Address - Country:US
Practice Address - Phone:757-685-8585
Practice Address - Fax:757-432-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty