Provider Demographics
NPI:1982046611
Name:CHOICES FOR LIFE
Entity type:Organization
Organization Name:CHOICES FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-751-0800
Mailing Address - Street 1:4101 PERIMETER CENTER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2302
Mailing Address - Country:US
Mailing Address - Phone:405-751-0800
Mailing Address - Fax:
Practice Address - Street 1:724 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4660
Practice Address - Country:US
Practice Address - Phone:918-248-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency