Healthcare Provider Details

I. General information

NPI: 1255031332
Provider Name (Legal Business Name): CHOSEN LIFE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 COUNTY ROAD 415
TOWN CREEK AL
35672-3332
US

IV. Provider business mailing address

PO BOX 14
TOWN CREEK AL
35672-0014
US

V. Phone/Fax

Practice location:
  • Phone: 256-633-1081
  • Fax:
Mailing address:
  • Phone: 256-633-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ADA WILSON
Title or Position: OWNER
Credential: FNP-BC
Phone: 256-443-9037