Provider Demographics
NPI:1912171836
Name:LIFE'S CHOICES, INC
Entity Type:Organization
Organization Name:LIFE'S CHOICES, INC
Other - Org Name:LIFE'S DOORS LIFELINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANGENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, MBA, PHD
Authorized Official - Phone:208-344-9228
Mailing Address - Street 1:PO BOX 5754
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-0754
Mailing Address - Country:US
Mailing Address - Phone:208-344-9228
Mailing Address - Fax:
Practice Address - Street 1:420 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1238
Practice Address - Country:US
Practice Address - Phone:208-344-9228
Practice Address - Fax:208-336-7516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807998100Medicaid