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General NPI Number Information
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NPI Number | 1962103176
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Entity Type | Organization
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Legal Business Name | LIFE'S INTENTION BACK TO BASICS INC.
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 920 SW FRAZER AVE STE 212
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City | PENDLETON
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State | OR
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Zip | 97801-2802
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Country | US
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Telephone | 541-969-1941
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Fax |
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Provider Business Mailing Address
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Address Line | 920 SW FRAZER AVE STE 212
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City | PENDLETON
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State | OR
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Zip | 97801-2802
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Country | US
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Telephone | 541-969-1941
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Fax | 541-429-4941
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Authorized Official
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Title or Position | OWNER
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Name | AMY MADRIGAL-BATES
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Credential | LPCA, CADC II, QMHP
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Telephone | 541-969-1941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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