MEDICARE: CHOICES FOR LIFE FOSTER CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	K8600134	OK

General Provider Information

NPI Number	:	1871651802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICES FOR LIFE FOSTER CARE, INC

Provider Business Mailing Address
First Line	:	4101 PERIMETER CENTER DR STE 250
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2309
Country	:	US
Telephone Number	:	405-751-0800
Fax Number	:	405-751-6488

Provider Business Practice Location Address
First Line	:	4101 PERIMETER CENTER DR
Second Line	:	SUITE 250
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2302
Country	:	US
Telephone Number	:	405-751-0800
Fax Number	:	405-751-6488

Authorized Official
Title or Position	:	CEO
Name	:	MR. DOUGLAS CHARLES FELLRATH
Credential	:	ATTORNEY
Telephone Number	:	405-751-0800

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	12/30/2008

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