Organization
LIFECHOICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIANA OLUSHOLA GREENE (VICE PRESIDENT)
(612) 328-4819
Entity
Organization
Contact information
Practice address
417 E MAIN ST STE A, FARMINGTON, NM 87401-2752
(612) 328-4819
Mailing address
417 E MAIN ST STE A, FARMINGTON, NM 87401-2752
(612) 328-4819
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
928-209-3295
TELEPHONE
NM
Enumeration date
03/05/2019
Last updated
03/05/2019
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