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General NPI Number Information
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NPI Number | 1316437866
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Entity Type | Organization
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Legal Business Name | LIFE CHOICE TREATMENT CENTER
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 10214 CADDO TRL
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City | MAGNOLIA
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State | TX
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Zip | 77354-4007
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Country | US
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Telephone | 337-356-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 7634 LA HWY 700
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City | KAPLAN
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State | LA
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Zip | 70548-6122
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Country | US
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Telephone | 337-356-1516
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHIAUS GUIDRY
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Credential |
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Telephone | 337-356-1516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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