MEDICARE: LIFE CHOICES GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1386058626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CHOICES GROUP

Provider Business Mailing Address
First Line	:	4921 ALBEMARLE RD
Second Line	:	SUITE 116
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4921 ALBEMARLE RD
Second Line	:	SUITE 116
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6654
Country	:	US
Telephone Number	:	980-307-2633
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JOANNA BURCH
Credential	:
Telephone Number	:	980-307-2633

Provider Enumeration Date	:	06/15/2014
Last Update Date	:	06/15/2014

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Directions to “LIFE CHOICES GROUP ” Practice Location

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