Provider Demographics
NPI:1841328960
Name:CHOICES FOR LIFE OF GEORGIA, LLC
Entity type:Organization
Organization Name:CHOICES FOR LIFE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:229-244-1707
Mailing Address - Street 1:2200 N PATTERSON STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2573
Mailing Address - Country:US
Mailing Address - Phone:229-244-1707
Mailing Address - Fax:229-244-1779
Practice Address - Street 1:2200 N PATTERSON STREET
Practice Address - Street 2:SUITE D
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2573
Practice Address - Country:US
Practice Address - Phone:229-244-1707
Practice Address - Fax:229-244-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPFC001072251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001462443AMedicaid
GA631155790AMedicaid