Healthcare Provider Details

I. General information

NPI: 1508553231
Provider Name (Legal Business Name): CHOOSE LIFE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8385 N 7TH ST
PHOENIX AZ
85020-3440
US

IV. Provider business mailing address

PO BOX 50481
PHOENIX AZ
85076-0481
US

V. Phone/Fax

Practice location:
  • Phone: 480-228-7800
  • Fax:
Mailing address:
  • Phone: 480-228-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CROWDER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 480-228-7800