Healthcare Provider Details

I. General information

NPI: 1124729314
Provider Name (Legal Business Name): LIFE'S INTENTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW FRAZER AVE STE 212
PENDLETON OR
97801-2802
US

IV. Provider business mailing address

920 SW FRAZER AVE STE 212
PENDLETON OR
97801-2802
US

V. Phone/Fax

Practice location:
  • Phone: 541-969-1941
  • Fax: 541-429-4941
Mailing address:
  • Phone: 541-969-1941
  • Fax: 541-429-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY MADRIGAL-BATES
Title or Position: OWNER
Credential: LPCA, CADC II, QMHP
Phone: 541-969-1941