Provider Demographics
NPI:1255031332
Name:CHOSEN LIFE HEALTHCARE, LLC
Entity type:Organization
Organization Name:CHOSEN LIFE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:256-443-9037
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:TOWN CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35672-0014
Mailing Address - Country:US
Mailing Address - Phone:256-633-1081
Mailing Address - Fax:
Practice Address - Street 1:588 COUNTY ROAD 415
Practice Address - Street 2:
Practice Address - City:TOWN CREEK
Practice Address - State:AL
Practice Address - Zip Code:35672-3332
Practice Address - Country:US
Practice Address - Phone:256-633-1081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health